WorldWideScience

Sample records for failure advancing policies

  1. Planning Ahead: Advanced Heart Failure

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Planning Ahead: Advanced Heart Failure Updated:Sep 30,2016 ... making your preferences known is called advance care planning. It allows you to speak for yourself, even ...

  2. Advanced Heart Failure

    Science.gov (United States)

    ... patients and their doctors, making good decisions requires teamwork. Through shared decision making, doctors and patients consider ... Heart Failure and Knowing Your Options Planning Ahead Communicating With Your Healthcare Provider Overcoming Barriers to Shared ...

  3. Management of advanced heart failure.

    Science.gov (United States)

    Van Bakel, Adrian B; Chidsey, Geoffrey

    2002-01-01

    Congestive heart failure (CHF) due to progressive systolic dysfunction has become a modern-day epidemic. Despite the increased incidence and prevalence, significant progress has been made in the past 10 to 15 years in the treatment of CHF at all stages. The current outlook for patients with newly diagnosed, mild heart failure is encouraging. It should be noted, however, that most of the morbidity and health care expenditure is incurred by a minority of patients diagnosed with CHF who are in the advanced stages of their disease. The thrust of this article will be to provide practical advice beyond current guidelines on the management of advanced CHF.

  4. Advanced Placement: Model Policy Components. Policy Analysis

    Science.gov (United States)

    Zinth, Jennifer

    2016-01-01

    Advanced Placement (AP), launched in 1955 by the College Board as a program to offer gifted high school students the opportunity to complete entry-level college coursework, has since expanded to encourage a broader array of students to tackle challenging content. This Education Commission of the State's Policy Analysis identifies key components of…

  5. Failure and damage analysis of advanced materials

    CERN Document Server

    Sadowski, Tomasz

    2015-01-01

    The papers in this volume present basic concepts and new developments in failure and damage analysis with focus on advanced materials such as composites, laminates, sandwiches and foams, and also new metallic materials. Starting from some mathematical foundations (limit surfaces, symmetry considerations, invariants) new experimental results and their analysis are shown. Finally, new concepts for failure prediction and analysis will be introduced and discussed as well as new methods of failure and damage prediction for advanced metallic and non-metallic materials. Based on experimental results the traditional methods will be revised.

  6. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob

    2016-01-01

    Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements...... in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

  7. Advanced glycation endproducts in chronic heart failure

    NARCIS (Netherlands)

    Smit, Andries J.; Hartog, Jasper W. L.; Voors, Adriaan A.; van Veldhuisen, Dirk J.; Schleicher, E; Somoza,; Shieberle, P

    2008-01-01

    Advanced glycation endproducts (AGEs) have been proposed as factors involved in the development and progression of chronic heart failure (CHF). Cross-linking by AGEs results in vascular and myocardial stiffening, which are hallmarks in the pathogenesis of CHE Additionally, stimulation of receptors b

  8. Advances in gene therapy for heart failure.

    Science.gov (United States)

    Fish, Kenneth M; Ishikawa, Kiyotake

    2015-04-01

    Chronic heart failure is expected to increase its social and economic burden as a consequence of improved survival in patients with acute cardiac events. Cardiac gene therapy holds significant promise in heart failure treatment for patients with currently very limited or no treatment options. The introduction of adeno-associated virus (AAV) gene vector changed the paradigm of cardiac gene therapy, and now it is the primary vector of choice for chronic heart failure gene therapy in clinical and preclinical studies. Recently, there has been significant progress towards clinical translation in this field spearheaded by AAV-1 mediated sarcoplasmic reticulum Ca2+ ATPase (SERCA2a) gene therapy targeting chronic advanced heart failure patients. Meanwhile, several independent laboratories are reporting successful gene therapy approaches in clinically relevant large animal models of heart failure and some of these approaches are expected to enter clinical trials in the near future. This review will focus on gene therapy approaches targeting heart failure that is in clinical trials and those close to its initial clinical trial application.

  9. Recognizing Advanced Heart Failure and Knowing Your Options

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Recognizing Advanced Heart Failure and Knowing Your Options Updated:Mar 25,2016 ... need in the future. Treatment Options for Advanced Heart Failure Major Interventions Open-heart surgery: For patients with ...

  10. Environmental Sustainability: A Case of Policy Implementation Failure?

    Directory of Open Access Journals (Sweden)

    Michael Howes

    2017-01-01

    Full Text Available For a generation, governments around the world have been committed to sustainable development as a policy goal. This has been supported by an array of new policies ranging from international agreements, to national strategies, environmental laws at many levels of government, regional programs, and local plans. Despite these efforts, decades of scientific monitoring indicate that the world is no closer to environmental sustainability and in many respects the situation is getting worse. This paper argues that a significant contributing factor to this situation is policy implementation failure. A systematic review of the literature reveals that the failure to achieve the intended outcomes of environmental policies is due to economic, political and communication factors. Conflict between the objectives of environmental policies and those focused on economic development, a lack of incentives to implement environmental policies, and a failure to communicate objectives to key stakeholders are all key factors that contribute to the inability to attain environmental sustainability.

  11. Energy efficiency, market failures, and government policy

    Energy Technology Data Exchange (ETDEWEB)

    Levine, M.D.; Koomey, J.G.; McMahon, J.E.; Sanstad, A.H. [Lawrence Berkeley Lab., CA (United States). Energy and Environment Div.; Hirst, E. [Oak Ridge National Lab., TN (United States). Energy Div.

    1994-03-01

    This paper presents a framework for evaluating engineering-economic evidence on the diffusion of energy efficiency improvements. Four examples are evaluated within this framework. The analysis provides evidence of market failures related to energy efficiency. Specific market failures that may impede the adoption of cost-effective energy efficiency are discussed. Two programs that have had a major impact in overcoming these market failures, utility DSM programs and appliance standards, are described.

  12. Generic policy in Bulgaria: a policy of failure or success?

    Directory of Open Access Journals (Sweden)

    Assena Stoimenova

    2016-09-01

    Full Text Available Generic medicines play a key role in managing the financial resources for pharmaceuticals in every country. This study analysed the generic policy legislative framework in Bulgaria with the aim to identify whether the policy implementation can be considered successful in the light of an international review of such policies introduced in other countries, or on the contrary, it has failed to deliver the main benefits. Legislative analysis, desktop study and macroeconomic overview of the Bulgarian pharmaceutical market were included. The study showed that only 3 out of 11 important policy elements are implemented in the country. Bulgaria has one of the highest shares of generics, an average of 81.39% (volume, for the studied period (2006–2014. However, further research is needed to evaluate the success of the existing generic policy in Bulgaria, as the market share of generic drugs is not the only measure of the policy efficiency.

  13. Recent advances in treatment of heart failure

    OpenAIRE

    Kitai, Takeshi; Tang, WH Wilson

    2015-01-01

    With the total cases and economic burden of heart failure continuing to rise, there is an overwhelming need for novel therapies. Several drugs for heart failure have succeeded in preclinical and early-phase clinical trials, but most of them failed to show the real benefit in pivotal clinical trials. Meanwhile, the US Food and Drug Administration recently approved two promising new drugs to treat heart failure: ivabradine and sacubitril/valsartan. Furthermore, some of the newer agents in testi...

  14. Seeds of Failure in Colbert's Baltic Policy.

    Science.gov (United States)

    Mackey, Richard William

    1984-01-01

    This investigation of French mercantilist initiatives and policies in the seventeenth century focuses on the attempts of Colbert, the controller general of finance to Louis XIV, to stimulate French trade with the Baltic by establishing a Company of the North. (RM)

  15. Market failure, policy failure and other distortions in chronic disease markets

    Directory of Open Access Journals (Sweden)

    Segal Leonie

    2009-06-01

    Full Text Available Abstract Background The increasing prevalence of chronic disease represents a significant burden on most health systems. This paper explores the market failures and policy failures that exist in the management of chronic diseases. Discussion There are many sources of market failure in health care that undermine the efficiency of chronic disease management. These include incomplete information as well as information asymmetry between providers and consumers, the effect of externalities on consumer behaviour, and the divergence between social and private time preference rates. This has seen government and policy interventions to address both market failures and distributional issues resulting from the inability of private markets to reach an efficient and equitable distribution of resources. However, these have introduced a series of policy failures such as distorted re-imbursement arrangements across modalities and delivery settings. Summary The paper concludes that market failure resulting from a preference of individuals for 'immediate gratification' in the form of health care and disease management, rather than preventative services, where the benefits are delayed, has a major impact on achieving an efficient allocation of resources in markets for the management of chronic diseases. This distortion is compounded by government health policy that tends to favour medical and pharmaceutical interventions further contributing to distortions in the allocation of resources and inefficiencies in the management of chronic disease.

  16. Antimicrobial resistance and biological governance: explanations for policy failure.

    Science.gov (United States)

    Wallinga, D; Rayner, G; Lang, T

    2015-10-01

    The paper reviews the state of policy on antimicrobial use and the growth of antimicrobial resistance (AMR). AMR was anticipated at the time of the first use of antibiotics by their originators. For decades, reports and scientific papers have expressed concern about AMR at global and national policy levels, yet the problem, first exposed a half-century ago, worsened. The paper considers the explanations for this policy failure and the state of arguments about ways forward. These include: a deficit of economic incentivisation; complex interventions in behavioural dynamics; joint and separate shifts in medical and animal health regimes; consumerism; belief in technology; and a narrative that in a 'war on bugs' nature can be beaten by human ingenuity. The paper suggests that these narratives underplay the biological realities of the human-animal-biosphere being in constant flux, an understanding which requires an ecological public health analysis of AMR policy development and failure. The paper suggests that effective policy change requires simultaneous actions across policy levels. No single solution is possible, since AMR is the result of long-term human intervention which has accelerated certain trends in the evolution of a microbial ecosystem shared by humans, animals and other biological organisms inhabiting that ecosystem. Viewing the AMR crisis today through an ecological public health lens has the advantage of reuniting the social-ecological and bio-ecological perspectives which have been separated within public health.

  17. Advanced Congestive Heart Failure Associated With Disseminated Intravascular Coagulopathy.

    Science.gov (United States)

    Sarcon, Annahita; Liu, Xiaoli; Ton, David; Haywood, James; Hitchcock, Todd

    2015-01-01

    Background. Disseminated intravascular coagulopathy (DIC) is a complication of an underlying disease and not a primary illness. It is most commonly associated with sepsis, trauma, obstetrical complications, and malignancies. There are very few cases in the literature illustrating the association between DIC and congestive heart failure. Findings. In this report, we present a case of severe congestive heart failure, leading to biventricular thrombi and subsequently DIC. Conclusion. We suggest that the association between congestive heart failure and DIC is an underrecognized one. Congestive heart failure continues to remain a major cause of morbidity and mortality despite advances in medical therapies. Thus far, the precise role of coagulation factors in congestive heart failure is unknown. Further investigations are needed to elucidate the pathophysiology of congestive heart failure and coagulation factors.

  18. Progressive Failure Analysis of Advanced Composites

    Science.gov (United States)

    2008-07-25

    NASA – Langley Research Center 1 Joan Andreu Mayugo University of Girona 1 2 Contents 1 Introduction 11 2 UVARM subroutine 13 2.1 Overview...32] Turon A, Camanho PP, Costa J, Dávila CG. A damage model for the simulation of delamination in advanced composites under variable- mode loading...conference, New York, 1960. p. 63–78. [34] Turon A, Dávila CG, Camanho PP, Costa J. An engineering solution for using coarse meshes in the

  19. Advanced approaches to failure mode and effect analysis (FMEA applications

    Directory of Open Access Journals (Sweden)

    D. Vykydal

    2015-10-01

    Full Text Available The present paper explores advanced approaches to the FMEA method (Failure Mode and Effect Analysis which take into account the costs associated with occurrence of failures during the manufacture of a product. Different approaches are demonstrated using an example FMEA application to production of drawn wire. Their purpose is to determine risk levels, while taking account of the above-mentioned costs. Finally, the resulting priority levels are compared for developing actions mitigating the risks.

  20. Surgical therapy in advanced heart failure.

    Science.gov (United States)

    Vitali, Ettore; Colombo, Tiziano; Fratto, Pasquale; Russo, Claudio; Bruschi, Giuseppe; Frigerio, Maria

    2003-05-08

    Congestive heart failure (CHF) affects about 1% of adults in the United States and is a contributing factor in >250,000 deaths per year. In an increasingly elderly population, the surgical treatment of CHF made great progress during the past 3 decades, consuming enormous health care resources. Heart transplantation is still the most effective therapy for end-stage heart disease, with the 10-year survival rate after transplantation approaching 50%. Efforts to increase the supply of donor organs have failed to improve the shortage, underscoring the crucial need for alternatives to cardiac allotransplantation. Alternative surgical options to end-stage heart transplantation are rapidly evolving. Left ventricular assist devices have been used as a bridge to heart transplantation for patients who otherwise might die awaiting a new heart. There is also continued interest in the use of these devices either to bridge patients to full recovery or to destination therapy, without the need for heart replacement. Left ventricular reconstruction, including the Batista and Dor procedures, along with mitral valve repair, cardiomyoplasty, and extreme coronary artery bypass graft surgery, are now being increasingly performed as alternative options. The history, status, and personal experience of surgical treatment of end-stage heart disease are discussed.

  1. Technological advances in extracorporeal membrane oxygenation for respiratory failure.

    Science.gov (United States)

    Rehder, Kyle J; Turner, David A; Bonadonna, Desiree; Walczak, Richard J; Rudder, Robert J; Cheifetz, Ira M

    2012-08-01

    Extracorporeal membrane oxygenation (ECMO) for neonatal and pediatric cardiac and/or respiratory failure is well established, and its use for adult respiratory failure is rapidly increasing. Management strategies developed over the past 30 years coupled with significant recent technological advances have led to improved ECMO survival. These new technologies are expanding the potential applications for ECMO in exciting ways, including new patient populations and the ability to make ECMO mobile for both intra- and inter-hospital transport. In this article, we highlight some of the recent technological advances and their impact on the utilization of ECMO in increasingly diverse patient populations.

  2. The Genetic Challenges and Opportunities in Advanced Heart Failure.

    Science.gov (United States)

    Hannah-Shmouni, Fady; Seidelmann, Sara B; Sirrs, Sandra; Mani, Arya; Jacoby, Daniel

    2015-11-01

    The causes of heart failure are diverse. Inherited causes represent an important clinical entity and can be divided into 2 major categories: familial and metabolic cardiomyopathies. The distinct features that might be present in early disease states can become broadly overlapping with other diseases, such as in the case of inherited cardiomyopathies (ie, familial hypertrophic cardiomyopathy or mitochondrial diseases). In this review article, we focus on genetic issues related to advanced heart failure. Because of the emerging importance of this topic and its breadth, we sought to focus our discussion on the known genetic forms of heart failure syndromes, genetic testing, and newer data on pharmacogenetics and therapeutics in the treatment of heart failure, to primarily encourage clinicians to place a priority on the diagnosis and treatment of these potentially treatable conditions.

  3. Relaxed resource advance reservation policy in grid computing

    Institute of Scientific and Technical Information of China (English)

    XIAO Peng; HU Zhi-gang

    2009-01-01

    The advance reservation technique has been widely applied in many grid systems to provide end-to-end quality of service (QoS). However, it will result in low resource utilization rate and high rejection rate when the reservation rate is high. To mitigate these negative effects brought about by advance reservation, a relaxed advance reservation policy is proposed, which allows accepting new reservation requests that overlap the existing reservations under certain conditions. Both the benefits and the risks of the proposed policy are presented theoretically. The experimental results show that the policy can achieve a higher resource utilization rate and lower rejection rate compared to the conventional reservation policy and backfilling technique. In addition, the policy shows better adaptation when the grid systems are in the presence of a high reservation rate.

  4. Advanced glycation end products in renal failure: an overview.

    Science.gov (United States)

    Noordzij, M J; Lefrandt, J D; Smit, A J

    2008-12-01

    The article aims to present an overview of the existing knowledge on advanced glycation end products (AGE). They are moieties that bind to proteins, but also lipids and nuclear acids. AGE are formed during glycation and oxidative stress. Accumulation of AGE occurs especially in diabetes and chronic renal failure and plays a major pathogenetic role. The deleterious effects of AGE result from cross-linking of proteins and activation of the receptor for advanced glycation end products. AGE accumulation can be noninvasively assessed by the skin autofluorescence reader. In diabetics, the skin autofluorescence predicts cardiac mortality and the occurrence of macro- and microvascular complications. In patients on haemodialysis, skin autofluorescence is highly elevated and predicts mortality. After renal transplantation AGE accumulation is lower than during haemodialysis, but still remains elevated and is a strong risk factor for chronic renal transplant dysfunction. Some of the potential methods to intervene with AGE accumulation are discussed in this article.

  5. Medical advances in the treatment of congestive heart failure.

    Science.gov (United States)

    Armstrong, P W; Moe, G W

    1993-12-01

    The increased incidence and prevalence of congestive heart failure place a high priority on novel treatment strategies. Left ventricular ejection fraction remains the single most valuable measurement providing both diagnostic and prognostic insights. The most systematic approach to heart failure involves an objective assessment of functional disability, to include exercise tests such as a 6-minute walk under standardized conditions. Left ventricular dysfunction incites a host of neurohumoral compensations that are of fundamental importance in the heart failure syndrome expression. Both vasoconstrictor and vasodilator neurohormones are stimulated and provide new therapeutic opportunities. The therapeutic approach to heart failure begins with a strong emphasis on prevention, patient education, and self-participation in therapy with respect to both its monitoring and adjustment. Diuretics remain a mainstay of therapy but, in the face of severe heart failure, may become ineffectual, requiring constant infusion of loop-active diuretics, combination diuretics, or diuretics in association with concomitant low-dose dopamine infusion. Vasodilator therapy has been an important advance: combination hydralazine and nitrate therapy was initially shown to be efficacious in improving survival, and more recently, angiotensin-converting enzyme (ACE) inhibitors, in the form of enalapril, have shown incremental benefit on survival over this combination. Interestingly, there is now evidence from both SOLVD and SAVE to demonstrate an unexpected and, as yet, unexplained reduction in the frequency of both unstable angina and myocardial infarction. Although, on balance, the weight of evidence concerning the long-term efficacy of inotropic agents has been disappointing, especially as it relates to their unfavorable effects on survival, recent information on vesnarinone, an agent with a complex and diversified mechanism of action, suggests that with appropriate doses, improved symptoms and

  6. [Population policy: substantial but insufficient advances].

    Science.gov (United States)

    Rodriguez Y Gonzalez, A

    1988-01-01

    Population policy was revised in Mexico in 1973 following the introduction of family planning and the abolition of rules prohibiting contraceptives. The laws of 1936 and 1947 favored population growth, but it was due to the improvement of public health (and the resulting drop in mortality rates), agricultural reform, and industrialization that an accelerated demographic expansion occurred. The National Council on Population (CONAPO) was created whose activities include family planning with modern contraceptive technology and maternal-infant health care. In accordance with the goals set in 1977, population growth is sought to be reduced to 1%/year by the year 2000. Public educational programs about reproduction, the family, and the community have been launched. The integration of women into the development of the country under the aegis of the Comision Nacional de las Mujer has not been fully achieved. The processing and analysis of demographic information for longterm policy development has also been limited. The lack of clear guidance from CONAPO has limited the involvement of state and municipal councils in the solution of Mexico's population problems. Future challenges will focus on the legal framework for reconciling public and private interests, and the interaction of population programs and economic and social development. The centralized decision making of population policy has involved more organizations, but still more needs to be done.

  7. Managing palliative care for adults with advanced heart failure.

    Science.gov (United States)

    Kaasalainen, Sharon; Strachan, Patricia H; Brazil, Kevin; Marshall, Denise; Willison, Kathleen; Dolovich, Lisa; Taniguchi, Alan; Demers, Catherine

    2011-09-01

    The purpose of this study was to explore the care processes experienced by community-dwelling adults dying from advanced heart failure, their family caregivers, and their health-care providers. A descriptive qualitative design was used to guide data collection, analysis, and interpretation. The sample comprised 8 patients, 10 informal caregivers, 11 nurses, 3 physicians, and 3 pharmacists. Data analysis revealed that palliative care was influenced by unique contextual factors (i.e., cancer model of palliative care, limited access to resources, prognostication challenges). Patients described choosing interventions and living with fatigue, pain, shortness of breath, and functional decline. Family caregivers described surviving caregiver burden and drawing on their faith. Health professionals described their role as trying to coordinate care, building expertise, managing medications, and optimizing interprofessional collaboration. Participants strove towards 3 outcomes: effective symptom management, satisfaction with care, and a peaceful death.

  8. Policy issues inherent in advanced technology development

    Energy Technology Data Exchange (ETDEWEB)

    Baumann, P.D.

    1994-12-31

    In the development of advanced technologies, there are several forces which are involved in the success of the development of those technologies. In the overall development of new technologies, a sufficient number of these forces must be present and working in order to have a successful opportunity at developing, introducing and integrating into the marketplace a new technology. This paper discusses some of these forces and how they enter into the equation for success in advanced technology research, development, demonstration, commercialization and deployment. This paper limits itself to programs which are generally governmental funded, which in essence represent most of the technology development efforts that provide defense, energy and environmental technological products. Along with the identification of these forces are some suggestions as to how changes may be brought about to better ensure success in a long term to attempt to minimize time and financial losses.

  9. An Examination of Two Policy Networks Involved in Advancing Smokefree Policy Initiatives.

    Science.gov (United States)

    Moreland-Russell, Sarah; Carothers, Bobbi J

    2015-09-01

    This study examines smokefree policy networks in two cities—Kansas City and St. Louis, Missouri—one that was successful in achieving widespread policy success, and one that was not. Descriptive social network analyses and visual network mapping were used to compare importance and contact relationships among actors involved in the smokefree policy initiatives. In Kansas City, where policy adoption was achieved, there was a higher level of connectivity among members, with network members being in contact with an average of more than five people, compared to just over two people for the St. Louis network. For both cities, despite being recognized as important, politicians were in contact with the fewest number of people. Results highlight the critical need to actively engage a variety of stakeholders when attempting city wide public health policy change. As evident by the success in smokefree policy adoption throughout Kansas City compared to St. Louis, closer linkages and continued communication among stakeholders including the media, coalitions, public health agencies, policymakers, and other partners are essential if we are to advance and broaden the impact of public health policy. Results indicate that the presence of champions, or those that play leadership roles in actively promoting policy by linking individuals and organizations, play an important role in advancing public health policy. Those working in public health should examine their level of engagement with the policy process and implement strategies for improving that engagement through relationship building and ongoing interactions with a variety of stakeholders, including policymakers.

  10. Global health diplomacy: advancing foreign policy and global health interests.

    Science.gov (United States)

    Michaud, Josh; Kates, Jennifer

    2013-03-01

    Attention to global health diplomacy has been rising but the future holds challenges, including a difficult budgetary environment. Going forward, both global health and foreign policy practitioners would benefit from working more closely together to achieve greater mutual understanding and to advance respective mutual goals.

  11. Why the Fed's monetary policy has been a failure

    National Research Council Canada - National Science Library

    Ranson, R. David

    2014-01-01

    .... Expectations that current monetary policy tools will have the desired effects on credit volume and economic growth lack straightforward empirical verification in the long sweep of US history. 3...

  12. HOUSING POLICIES AND MARKET FAILURES IN ONDO STATE NIGERIA

    Directory of Open Access Journals (Sweden)

    Afolabi Francis FATUSIN

    2014-06-01

    Full Text Available One major factor that account for housing market crises in developing countries is the seeming disconnect between housing policies and housing markets in these countries. This paper examines the links between housing policy and urban housing market dynamics in context of developing world drawing from the housing market situation in selected urban centres in Ondo state of Nigeria. The data utilized were derived from the study of housing situations in the selected urban centres. Thus 180 questionnaires were administered on selected household heads and key officials of major agencies and organizations including government departments involved in housing provision and development in the state. The data collected were analyzed using simple descriptive analysis where appropriate. The study revealed that housing policies introduced over the years have had little impact on housing production and by implication urban housing market in the study cities. The study also revealed a disconnect between these policies and housing provision and trends in terms of quality, quantity, affordability and accessibility to housing. The paper argued that these were so because institutions connected to efficient functioning of these policies were inefficient, ineffective and sometime over ambitious and so more often than not, set goals were not met. The study concluded by suggesting more commitment on the part of Federal and Ondo state governments to ensure these policies dovetail to housing consumers.

  13. Advancing LGBT Elder Policy and Support Services: The Massachusetts Model.

    Science.gov (United States)

    Krinsky, Lisa; Cahill, Sean

    2017-04-04

    The Massachusetts-based LGBT Aging Project has trained elder service providers in affirming and culturally competent care for LGBT older adults, supported development of LGBT-friendly meal programs, and advanced LGBT equality under aging policy. Working across sectors, this innovative model launched the country's first statewide Legislative Commission on Lesbian, Gay, Bisexual, and Transgender Aging. Advocates are working with policymakers to implement key recommendations, including cultural competency training and data collection in statewide networks of elder services. The LGBT Aging Project's success provides a template for improving services and policy for LGBT older adults throughout the country.

  14. Advanced health biotechnologies in Thailand: redefining policy directions

    Directory of Open Access Journals (Sweden)

    Velasco Román Pérez

    2013-01-01

    Full Text Available Abstract Background Thailand faces a significant burden in terms of treating and managing degenerative and chronic diseases. Moreover, incidences of rare diseases are rising. Many of these—such as diabetes, cancer, and inherited inborn metabolic diseases—have no definite treatments or cure. Meanwhile, advanced health biotechnology has been found, in principle, to be an effective solution for these health problems. Methods Qualitative approaches were employed to analyse the current situation and examine existing public policies related to advanced health biotechnologies in Thailand. The results of this analysis were then used to formulate policy recommendations. Results Our research revealed that the system in Thailand in relation to advanced health biotechnologies is fragmented, with multiple unaddressed gaps, underfunding of research and development (R&D, and a lack of incentives for the private sector. In addition, there are no clear definitions of advanced health biotechnologies, and coverage pathways are absent. Meanwhile, false advertising and misinformation are prevalent, with no responsible bodies to actively and effectively provide appropriate information and education (I&E. The establishment of a specialised institution to fill the gaps in this area is warranted. Conclusion The development and implementation of a comprehensive national strategic plan related to advanced health biotechnologies, greater investment in R&D and I&E for all stakeholders, collaboration among agencies, harmonisation of reimbursement across public health schemes, and provision of targeted I&E are specifically recommended.

  15. LOW-LEVEL RADIOACTIVE WASTE: POLICY FAILURE, REGIONAL FAILURE. (R823191)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  16. Behavioral economics and health policy: understanding Medicaid's failure.

    Science.gov (United States)

    Richman, Barak D

    2005-03-01

    This Article employs a behavioral economic analysis to understand why Medicaid has failed to improve the health outcomes of its beneficiaries. It begins with a formal economic model of health care consumption and then systematically incorporates a survey of psychosocial variables to formulate explanations for persistent health disparities. This methodology suggests that consulting the literature in health psychology and intertemporal decision theory--empirical sources generally excluded from orthodox economic analysis--provides valuable material to explain certain findings in health econometrics. More significantly, the lessons from this behavioral economic approach generate useful policy considerations for Medicaid policymakers, who largely have neglected psychosocial variables in implementing a health insurance program that rests chiefly on orthodox economic assumptions. The Article's chief contributions include an expansion of the behavioral economic approach to include a host of variables in health psychology, a behavioral refinement of empirical health economics, a behavioral critique of Medicaid policy, and a menu of suggested Medicaid reforms.

  17. Advanced cardiac imaging in heart failure : from subclinical myocardial dysfunction to therapy optimization

    NARCIS (Netherlands)

    Auger, Dominique

    2014-01-01

    Advanced echocardiographic techniques permit assessment of left ventricular dyssynchrony in overt heart failure patients and provide important prognostic data. These techniques may guide patients’ selection for cardiac resynchronization therapy and device optimization. Global left ventricular longit

  18. School failure and youth unemployment in Spain. Analysis and proposals for educational policy

    Directory of Open Access Journals (Sweden)

    Josep Oriol ESCARDÍBUL

    2016-07-01

    Full Text Available This article deals with school failure in Spain and its consequences on youth unemployment. This type of unemployment is reduced as young people reach higher levels of education. Moreover, since the less educated receive less training during their professional career, the reduction of school failure is a key to the subsequent reduction of youth unemployment. Failure is defined and analysed (within an European framework in three ways: lack of competences acquisition, not finishing compulsory education at the corresponding age, as well as the percentage of the population aged 18-24 with at most lower secondary education and not in further education or training. In the paper we review national and international studies on the causes of school failure (especially those at school or higher level and, considering the financial situation of the Spanish public sector, we suggest the implementation of several educational policies to reduce school failure (and, therefore, youth unemployment.

  19. Aboriginal cultural awareness training: policy v. accountability - failure in reality.

    Science.gov (United States)

    Westwood, Barbara; Westwood, Geoff

    2010-11-01

    Despite 42 years progress since the 1967 referendum enabling laws to be made covering Aboriginal Australians their poor health status remains and is extensively documented. This paper presents results of a study into Cultural Awareness Training (CAT) in New South Wales and specifically South West Sydney Area Health Service (SWSAHS) with the aim of improving long-term health gains. The evidence demonstrates poor definition and coordination of CAT with a lack of clear policy direction and accountability for improving cultural awareness at government level. In SWSAHS staff attendance at training is poor and training is fragmented across the Area. The paper proposes actions to improve Aboriginal cultural awareness for health professionals including incorporating Aboriginal CAT into broader based Cross Cultural Training (CCT).

  20. Advanced korean industrial safety and health policy with risk assessment.

    Science.gov (United States)

    Kwon, Hyuckmyun; Cho, Jae Hyun; Moon, Il; Choi, Jaewook; Park, Dooyong; Lee, Youngsoon

    2010-09-01

    This article describes a systematic roadmap master plan for advanced industrial safety and health policy in Korea, with an emphasis on. Since Korean industries had first emergence of industrial safety and health policy in 1953, enormous efforts have been made on upgrading the relevant laws in order to reflect real situation of industrial work environment in accordance with rapid changes of Korean and global business over three decades. Nevertheless, current policy has major defects; too much techniques-based articles, diverged contents in less organization, combined enforcement and punishments and finally enforcing regulations full of commands and control. These deficiencies have make it difficult to accommodate changes of social, industrial and employment environment in customized fashion. The approach to the solution must be generic at the level of paradigm-shift rather than local modifications and enhancement. The basic idea is to establish a new system integrated with a risk assessment scheme, which encourages employers to apply to their work environment under comprehensive responsibility. The risk assessment scheme is designed to enable to inspect employers' compliances afterwards. A project comprises four yearly phases based on applying zones; initially designating and operating a specified risk zone, gradually expanding the special zones during a period of 3 years (2010-2012) and the final zone expanded to entire nation. In each phase, the intermediate version of the system is updated through a process of precise and unbiased validation in terms of its operability, feasibility and sustainability with building relevant infrastructures as needed.

  1. International small dam safety assurance policy benchmarks to avoid dam failure flood disasters in developing countries

    Science.gov (United States)

    Pisaniello, John D.; Dam, Tuyet Thi; Tingey-Holyoak, Joanne L.

    2015-12-01

    In developing countries small dam failure disasters are common yet research on their dam safety management is lacking. This paper reviews available small dam safety assurance policy benchmarks from international literature, synthesises them for applicability in developing countries, and provides example application through a case study of Vietnam. Generic models from 'minimum' to 'best' practice (Pisaniello, 1997) are synthesised with the World Bank's 'essential' and 'desirable' elements (Bradlow et al., 2002) leading to novel policy analysis and design criteria for developing countries. The case study involved 22 on-site dam surveys finding micro level physical and management inadequacies that indicates macro dam safety management policy performs far below the minimum benchmark in Vietnam. Moving assurance policy towards 'best practice' is necessary to improve the safety of Vietnam's considerable number of hazardous dams to acceptable community standards, but firstly achieving 'minimum practice' per the developed guidance is essential. The policy analysis/design process provides an exemplar for other developing countries to follow for avoiding dam failure flood disasters.

  2. Renal histology in polycystic kidney disease with incipient and advanced renal failure.

    Science.gov (United States)

    Zeier, M; Fehrenbach, P; Geberth, S; Möhring, K; Waldherr, R; Ritz, E

    1992-11-01

    Renal specimens were obtained at surgery or postmortem from patients with autosomal dominant polycystic kidney disease (ADPKD). Patients had either serum creatinine (SCr) below 350 mumol/liter (N = 12) or terminal renal failure (N = 50). Specimens were examined by two independent observers using a carefully validated score system. Mean glomerular diameters were similar in ADPKD patients with early renal failure (176 +/- 38 microns) and in victims of traffic accidents (177 +/- 23 microns), while they were significantly greater in diabetics with comparable renal function (205 +/- 16 microns). Glomerular diameters in ADPKD patients with terminal renal failure (191 +/- 45 microns) and with early renal failure were not significantly different. On average, 29% of glomeruli (17 to 62) were globally sclerosed in early renal failure, and 49% (19 to 93) in terminal renal failure. The proportion of glomeruli with segmental sclerosis was less than 4% in both groups. Marked vascular sclerosis, interstitial fibrosis, and tubular atrophy were present in early renal failure, and even more so in terminal renal failure. Interstitial infiltrates were scarce and consisted mainly of CD4 positive lymphocytes and CD68 positive macrophages. Immunestaining with monoclonal renin antibodies showed an increased juxtaglomerular index and expression of renin by arterioles adjacent to cysts, as well as by cyst wall epithelia. The data show more severe vascular and interstitial, but not glomerular, changes in ADPKD with advanced as compared to early renal failure.

  3. Advanced glycation end-products (AGEs) and heart failure: pathophysiology and clinical implications.

    Science.gov (United States)

    Hartog, Jasper W L; Voors, Adriaan A; Bakker, Stephan J L; Smit, Andries J; van Veldhuisen, Dirk J

    2007-12-01

    Advanced glycation end-products (AGEs) are molecules formed during a non-enzymatic reaction between proteins and sugar residues, called the Maillard reaction. AGEs accumulate in the human body with age, and accumulation is accelerated in the presence of diabetes mellitus. In patients with diabetes, AGE accumulation is associated with the development of cardiac dysfunction. Enhanced AGE accumulation is not restricted to patients with diabetes, but can also occur in renal failure, enhanced states of oxidative stress, and by an increased intake of AGEs. Several lines of evidence suggest that AGEs are related to the development and progression of heart failure in non-diabetic patients as well. Preliminary small intervention studies with AGE cross-link breakers in heart failure patients have shown promising results. In this review, the role of AGEs in the development of heart failure and the role of AGE intervention as a possible treatment for heart failure are discussed.

  4. Advanced Renal Failure in Patients with Sickle Cell Anemia: Clinical Course and Prognosis

    Science.gov (United States)

    Cruz, Iluminado A.; Hosten, Adrian O.; Dillard, Martin G.; Castro, Oswaldo L.

    1982-01-01

    Advanced renal failure occurred in nine adult sickle cell disease patients. There were six men and three women with a mean age of 38.6 years. Eight patients had homozygous SS disease, one had sickle cell thalassemia. Three patients had acute renal failure from which they partially recovered. Six developed endstage kidney disease requiring dialysis. Two of these received a kidney transplant, and there was one death in the immediate postoperative period. Angina pectoris, hyperkalemia, and severe anemia complicated chronic dialysis, suggesting that early transplantation should be considered for sickle cell anemia patients with renal failure. PMID:6757451

  5. [Clinical competence certification for advanced heart failure: an emerging need also in Italy?].

    Science.gov (United States)

    Marini, Marco; Pini, Daniela; Russo, Giulia; Milli, Massimo; De Maria, Renata; Di Tano, Giuseppe; Aspromonte, Nadia

    2015-02-01

    Advanced heart failure (HF) is a deadly condition. Fortunately, an increasing array of effective (but often expensive) therapies has become available. The management of patients with advanced HF is complex and requires a high level of expertise. The American Board of Internal Medicine was the first regulatory board to recognize the need for a subspecialty in Advanced HF and Transplant Cardiology. More recently, the HF Association of the European Society of Cardiology has proposed a curriculum for HF specialists that includes the optional module of advanced HF therapy. However, the successful completion of such a curriculum does not result in a European Certification in Heart Failure, because no European Board of Medicine does exist. While in some European countries the secondary specialty of HF has been implemented, no country has a subspecialty in advanced HF. The ANMCO HF Area has proposed a survey to 25 Italian centers with accredited programs for heart transplant or ventricular assist device implant as destination therapy with the aim to assess the actual need of a certification of clinical competence in advanced HF and a certification of institutional competence for the centers with the highest expertise in advanced HF management. The survey indicated that there is a perceived need. A first step towards education of advanced HF specialists could be the implementation of CME courses by Scientific Societies. As regards certification of institutional competence for the centers with the highest expertise in advanced HF management, the government appears to be the only entity that can grant it.

  6. NEW ADVANCES IN BETA-BLOCKER THERAPY IN HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Vincenzo eBarrese

    2013-11-01

    Full Text Available The use of -blockers (BB in heart failure (HF has been considered a contradiction for many years. Considering HF simply as a state of inadequate systolic function, BB were contraindicated because of their negative effects on myocardial contractility. Nevertheless, evidence collected in the past years have suggested that additional mechanisms, such as compensatory neuro-humoral hyperactivation or inflammation, could participate in the pathogenesis of this complex disease. Indeed, chronic activation of the sympathetic nervous system, although initially compensating the reduced cardiac output from the failing heart, increases myocardial oxygen demand, ischemia and oxidative stress; moreover, high catecholamine levels induce peripheral vasoconstriction and increase both cardiac pre- and after-load, thus determining additional stress to the cardiac muscle (1. As a consequence of such a different view of the pathogenic mechanisms of HF, the efficacy of BB in the treatment of HF has been investigated in numerous clinical trials. Results from these trials highlighted BB as valid therapeutic tools in HF, providing rational basis for their inclusion in many HF treatment guidelines. However, controversy still exists about their use, in particular with regards to the selection of specific molecules, since BB differ in terms of adrenergic -receptors selectivity, adjunctive effects on -receptors, and effects on reactive oxygen species and inflammatory cytokines production. Further concerns about the heterogeneity in the response to , as well as the use in specific patients, are matter of debate among clinicians. In this review, we will recapitulate the pharmacological properties and the classification of BB, and the alteration of the adrenergic system occurring during HF that provide a rationale for their use; we will also focus on the possible molecular mechanisms, such as genetic polymorphisms, underlying the different efficacy of molecules

  7. Baclofen Induced Encephalopathy in a 6-Year-Old Boy with Advanced Renal Failure

    Directory of Open Access Journals (Sweden)

    Majid MALAK

    2015-06-01

    Full Text Available How to Cite This Article: Malak M, Barzgar M. Baclofen Induced Encephalopathy in a 6-Year-Old boy with Advanced Renal Failure. Iran J Child Neurol. Spring 2015;9(2:61-63. AbstractBaclofen is a drug for many diseases for all ages, but it is hazardous in patients with renal failure. This article talks about a case of baclofen overdose in a child with renal failure.A 6-year-old boy admitted to the emergency department with a loss of consciousness, hypotonia, and areflexia following administration of 20 mg baclofen (1mg/kg/daily in total dose for his voiding dysfunction. His laboratory tests showed advanced renal failure. After withholding the medication andsupportive therapy, he recovered completely after two days. After arousal, he complained of insomnia, strange sensations on the skin, intentional tremors, and ataxia. He left the hospital in good condition in three days.Renal function control before baclofen administration is mandatory especially in high-risk groups. A total dose of 1mg/kg lead to encephalopathy in children with advanced renal failure, with subtle persistent complaints persist are often overlooked for a while.

  8. Nutrition intervention to decrease symptoms in patients with advanced heart failure.

    Science.gov (United States)

    Lennie, Terry A; Moser, Debra K; Biddle, Martha J; Welsh, Darlene; Bruckner, Geza G; Thomas, D Travis; Rayens, Mary Kay; Bailey, Alison L

    2013-04-01

    For a majority of patients with advanced heart failure, there is a need for complementary, non-pharmacologic interventions that could be easily implemented by health care providers to provide palliative care. Three major pathologic pathways underlying heart failure symptoms have been identified: fluid overload, inflammation, and oxidative stress. Prior research has demonstrated that three nutrients-sodium, omega-3 fatty acids, and lycopene-can alter these pathologic pathways. Therefore, the purposes of this study are to test the effects of a 6-month nutrition intervention of dietary sodium reduction combined with supplementation of lycopene and omega-3 fatty acids on heart failure symptoms, health-related quality of life, and time to heart failure rehospitalization or all-cause death. The aims of this double blind-placebo controlled study are (1) to determine the effects of a 6-month nutrition intervention on symptom burden (edema, shortness of air, and fatigue) and health-related quality of life at 3 and 6 months, and time to heart failure rehospitalization or all-cause death over 12 months from baseline; (2) compare dietary sodium intake, inflammation, and markers of oxidative stress between the nutrition intervention group and a placebo group at 3 and 6 months; and (3) compare body weight, serum lycopene, and erythrocyte omega-3 index between the nutrition intervention group and a placebo group at 3 and 6 months. A total of 175 patients with advanced heart failure will be randomized to either the nutrition intervention or placebo group.

  9. Research on Scientific Data Sharing and Distribution Policy in Advanced Manufacturing and Automation Fields

    Directory of Open Access Journals (Sweden)

    Liya Li

    2007-12-01

    Full Text Available Scientific data sharing is a long-term and complicated task. The related data sharing and distribution policies are prime concerns. By using both domestic and international experiences in scientific data sharing, the sources, distribution, and classification of scientific data in advanced manufacturing and automation are discussed. A primary data sharing and distribution policy in advanced manufacture and automation is introduced.

  10. Role of long-term mechanical circulatory support in patients with advanced heart failure.

    Science.gov (United States)

    Stokes, M B; Bergin, P; McGiffin, D

    2016-05-01

    Advanced heart failure represents a small proportion of patients with heart failure that possess high-risk features associated with high hospital readmission rates, significant functional impairment and mortality. Identification of those who have progressed to, or are near a state of advanced heart failure should prompt referral to a service that offers therapies in mechanical circulatory support (MCS) and cardiac transplantation. MCS has grown as a management strategy in the care of these patients, most commonly as a bridge to cardiac transplantation. The predominant utilisation of MCS is implantation of left ventricular assist devices (LVAD), which have evolved significantly in their technology and application over the past 15-20 years. The technology has evolved to such an extent that Destination Therapy is now being utilised as a strategy in management of advanced heart failure in appropriately selected patients. Complication rates have decreased with VAD implantation, but remain a significant consideration in the decision to implant a device, and in the follow up of these patients.

  11. Advanced Inverter Functions to Support High Levels of Distributed Solar: Policy and Regulatory Considerations (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2014-11-01

    This paper explains how advanced inverter functions (sometimes called 'smart inverters') contribute to the integration of high levels of solar PV generation onto the electrical grid and covers the contributions of advanced functions to maintaining grid stability. Policy and regulatory considerations associated with the deployment of advanced inverter functions are also introduced.

  12. System Merits or Failures? Policies for Transition to Sustainable P and N Systems in The Netherlands and Finland

    Directory of Open Access Journals (Sweden)

    Thomas Hoppe

    2016-05-01

    Full Text Available Nitrogen (N and phosphorus (P cycles are absolutely vital in maintaining sustainable food systems. Human activities disturb the natural balance of these cycles by creating enormous additional nutrient fluxes, causing eutrophication of waterways and pollution in land systems. To tackle this problem, sustainable nutrient management is required. This paper addresses sustainable nutrient management in two countries: The Netherlands and Finland. We adopt a critical perspective on resource politics, especially towards opportunistic policy strategies for the pollutant management of N and P. Two research questions are considered. First, what are the key systemic and policy failures that occurred in the N and P systems in the Netherlands and Finland between 1970 and 2015? And second, which lessons can be drawn when addressing the policy responses in the two countries to cope with these failures? The cases are analyzed within Weber and Rohracher’s framework that addresses “failures” preventing sustainable transitions. The results show that a number of failures occurred, besides market failures (over-exploitation of the commons, externalization of costs: lack of directionality, policy coordination, institutions, capabilities, infrastructure, demand articulation, and reflexivity. Policy responses in both countries resulted in ponderous policy frameworks that were adequate to tackle nutrient problems from the industrial sector and municipalities. However, both countries provided only a moderate response in terms of system-wide integrated policy frameworks to cope with sectoral-transcending issues. The agricultural use of N and P, in contrast to detergents, has not been subjected to strong regulatory measures.

  13. Failure of policy regarding smoke-free bars in the Netherlands*

    Science.gov (United States)

    Gonzalez, Mariaelena

    2013-01-01

    Background: Tobacco companies consistently work to prevent and undermine smoke-free laws. The tobacco industry and its allies have funded hospitality associations and other third parties to oppose smoke-free laws, argue that smoke-free laws will economically damage hospitality venues, promote ventilation and voluntary smoker ‘accommodation’ as an alternative to smoke-free laws, and to challenge smoke-free laws in court. In 2008, the Netherlands extended its smoke-free law to hospitality venues. Methods: We triangulated news articles, government documents, scientific papers, statistical reports and interviews to construct this case study. Results: Despite widespread public support for smoke-free hospitality venues, opponents successfully represented these laws as unpopular and damaging to small bars. These challenges and related smokers’ rights activities resulted in non-compliance among all bars and reinstating an exemption for small, owner-run venues. This policy reversal was the result of a weak implementing media campaign (which failed to present the law as protecting nonsmokers), smoking room exemptions and reactive (vs. proactive) measures by the Ministry of Health and civil society. Conclusion: The policy failure in the Netherlands is the result of poor implementation efforts and the failure to anticipate and deal with opposition to the law. When implementing smoke-free laws it is important to anticipate opposition, used the media to target non-smokers to reinforce public support, and actively enforce the law. PMID:22143826

  14. Failure of policy regarding smoke-free bars in the Netherlands.

    Science.gov (United States)

    Gonzalez, Mariaelena; Glantz, Stanton A

    2013-02-01

    Tobacco companies consistently work to prevent and undermine smoke-free laws. The tobacco industry and its allies have funded hospitality associations and other third parties to oppose smoke-free laws, argue that smoke-free laws will economically damage hospitality venues, promote ventilation and voluntary smoker 'accommodation' as an alternative to smoke-free laws, and to challenge smoke-free laws in court. In 2008, the Netherlands extended its smoke-free law to hospitality venues. We triangulated news articles, government documents, scientific papers, statistical reports and interviews to construct this case study. Despite widespread public support for smoke-free hospitality venues, opponents successfully represented these laws as unpopular and damaging to small bars. These challenges and related smokers' rights activities resulted in non-compliance among all bars and reinstating an exemption for small, owner-run venues. This policy reversal was the result of a weak implementing media campaign (which failed to present the law as protecting nonsmokers), smoking room exemptions and reactive (vs. proactive) measures by the Ministry of Health and civil society. The policy failure in the Netherlands is the result of poor implementation efforts and the failure to anticipate and deal with opposition to the law. When implementing smoke-free laws it is important to anticipate opposition, used the media to target non-smokers to reinforce public support, and actively enforce the law.

  15. Carbon Lock-Out: Advancing Renewable Energy Policy in Europe

    Directory of Open Access Journals (Sweden)

    Robert Pietzcker

    2012-02-01

    Full Text Available As part of its climate strategy, the EU aims at increasing the share of electricity from renewable energy sources (RES-E in overall electricity generation. Attaining this target poses a considerable challenge as the electricity sector is “locked” into a carbon-intensive system, which hampers the adoption of RES-E technologies. Electricity generation, transmission and distribution grids as well as storage and demand response are subject to important path dependences, which put existing, non-renewable energy sources at an advantage. This paper examines how an EU framework for RES-E support policies should be designed to facilitate a carbon lock-out. For this purpose, we specify the major technological, economic and institutional barriers to RES-E. For each of the barriers, a policy review is carried out which assesses the performance of existing policy instruments and identifies needs for reform. The review reveals several shortcomings: while policies targeting generation are widely in place, measures to address barriers associated with electricity grids, storage and demand are still in their infancy and have to be extended. Moreover, the implementation of policies has been fragmented across EU Member States. In this respect, national policies should be embedded into an integrated EU-wide planning of the RES-E system with overarching energy scenarios and partially harmonized policy rules.

  16. Reconciling justice and attribution research to advance climate policy

    Science.gov (United States)

    Huggel, Christian; Wallimann-Helmer, Ivo; Stone, Dáithí; Cramer, Wolfgang

    2016-10-01

    The Paris Climate Agreement is an important step for international climate policy, but the compensation for negative effects of climate change based on clear assignment of responsibilities remains highly debated. From both a policy and a science perspective, it is unclear how responsibilities should be defined and on what evidence base. We explore different normative principles of justice relevant to climate change impacts, and ask how different forms of causal evidence of impacts drawn from detection and attribution research could inform policy approaches in accordance with justice considerations. We reveal a procedural injustice based on the imbalance of observations and knowledge of impacts between developed and developing countries. This type of injustice needs to be considered in policy negotiations and decisions, and efforts strengthened to reduce it.

  17. Advanced Placement in Studio Art and Secondary Art Education Policy: Countering the Null Curriculum

    Science.gov (United States)

    Graham, Mark A.; Sims-Gunzenhauser, Alice

    2009-01-01

    Because of education reform policy and misconceptions about artistry and artistic assessment, visual art education remains in the margins of high school education. One response to the lack of supportive arts education policy is the Advanced Placement (AP) Studio Art Program, a visual arts assessment at the high school level that engages large…

  18. Advanced strategies for end-stage heart failure: combining regenerative approaches with LVAD, a new horizon?

    Directory of Open Access Journals (Sweden)

    Cheyenne eTseng

    2015-04-01

    Full Text Available Despite the improved treatment of cardiovascular diseases the population with end-stage heart failure is progressively growing. The scarcity of the gold standard therapy, heart transplantation, demands novel therapeutic approaches. For patients awaiting transplantation ventricular assist devices have been of great benefit on survival. To allow explantation of the assist device and obviate heart transplantation, sufficient and durable myocardial recovery is necessary. However, explant rates so far are low. Combining mechanical circulatory support with regenerative therapies such as cell(-based therapy and biomaterials might give rise to improved long-term results. Although synergistic effects are suggested with mechanical support and stem cell therapy, evidence in both preclinical and clinical setting is lacking. This review focuses on advanced and innovative strategies for the treatment of end-stage heart failure and furthermore appraises clinical experience with combined strategies.

  19. An analysis of policy success and failure in formal evaluations of Australia's national mental health strategy (1992-2012).

    Science.gov (United States)

    Grace, Francesca C; Meurk, Carla S; Head, Brian W; Hall, Wayne D; Harris, Meredith G; Whiteford, Harvey A

    2017-05-30

    Heightened fiscal constraints, increases in the chronic disease burden and in consumer expectations are among several factors contributing to the global interest in evidence-informed health policy. The present article builds on previous work that explored how the Australian Federal Government applied five instruments of policy, or policy levers, to implement a series of reforms under the Australian National Mental Health Strategy (NMHS). The present article draws on theoretical insights from political science to analyse the relative successes and failures of these levers, as portrayed in formal government evaluations of the NMHS. Documentary analysis of six evaluation documents corresponding to three National Mental Health Plans was undertaken. Both the content and approach of these government-funded, independently conducted evaluations were appraised. An overall improvement was apparent in the development and application of policy levers over time. However, this finding should be interpreted with caution due to variations in evaluation approach according to Plan and policy lever. Tabulated summaries of the success and failure of each policy initiative, ordered by lever type, are provided to establish a resource that could be consulted for future policy-making. This analysis highlights the complexities of health service reform and underscores the limitations of narrowly focused empirical approaches. A theoretical framework is provided that could inform the evaluation and targeted selection of appropriate policy levers in mental health.

  20. Advancing the Field Elder Abuse: Future Directions and Policy Implications

    Science.gov (United States)

    Dong, XinQi

    2012-01-01

    Elder abuse, sometime called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse, neglect (caregiver neglect and self-neglect), and financial exploitation. Evidence suggests that 1 out of 10 older adult experiences some form of elder abuse, and only 1 of out 25 cases are actually reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy dealing with the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow/Health and Aging Policy Fellow working with Administration on Community Living (ACL) (Previously known at Administration on Aging (AoA)) for the last two years, I will describe the major functions of the ACL; and highlight on two major pieces of federal legislation: The Older Americans Act (OAA) and the Elder Justice Act (EJA). Moreover, I will highlight major research gaps and future policy relevant research directions for the field of elder abuse. PMID:23110488

  1. Durable mechanical circulatory support in advanced heart failure: a critical care cardiology perspective.

    Science.gov (United States)

    Lala, Anuradha; Mehra, Mandeep R

    2013-11-01

    Though cardiac transplantation for advanced heart disease patients remains definitive therapy for patients with advanced heart failure, it is challenged by inadequate donor supply, causing durable mechanical circulatory support (MCS) to slowly become a new primary standard. Selecting appropriate patients for MCS involves meeting a number of prespecifications as is required in evaluation for cardiac transplant candidacy. As technology evolves to bring forth more durable smaller devices, selection criteria for appropriate MCS recipients will likely expand to encompass a broader, less sick population. The "Holy Grail" for MCS will be a focus on clinical recovery and explantation of devices rather than the currently more narrowly defined indications of bridge to transplantation or lifetime device therapy. Copyright © 2013 Elsevier Inc. All rights reserved.

  2. [Implantable sensors for outpatient assessment of ventricular filling pressure in advanced heart failure : Which telemonitoring design is optimal?

    Science.gov (United States)

    Herrmann, E; Fichtlscherer, S; Hohnloser, S H; Zeiher, A M; Aßmus, B

    2016-12-01

    Patients with advanced heart failure suffer from frequent hospitalizations. Non-invasive hemodynamic telemonitoring for assessment of ventricular filling pressure has been shown to reduce hospitalizations. We report on the right ventricular (RVP), the pulmonary artery (PAP) and the left atrial pressure (LAP) sensor for non-invasive assessment of the ventricular filling pressure. A literature search concerning the available implantable pressure sensors for noninvasive haemodynamic telemonitoring in patients with advanced heart failure was performed. Until now, only implantation of the PAP-sensor was able to reduce hospitalizations for cardiac decompensation and to improve quality of life. The right ventricular pressure sensor missed the primary endpoint of a significant reduction of hospitalizations, clinical data using the left atrial pressure sensor are still pending. The implantation of a pressure sensor for assessment of pulmonary artery filling pressure is suitable for reducing hospitalizations for heart failure and for improving quality of life in patients with advanced heart failure.

  3. Advancing the Orang Asli through Malaysia's Clusters of Excellence Policy

    Directory of Open Access Journals (Sweden)

    Mohd Asri Mohd Noor

    2012-10-01

    Full Text Available Since gaining independence in 1957, the government of Malaysia has introduced various programmes to improve the quality of life of the Orang Asli (aboriginal people. The Ministry of Education, for example, is committed in providing education for all including the children of Orang Asli. However, whilst the number of Orang Asli children enrolled in primary and secondary schools has increased significantly over the last decade, the dropout rate among them is still high. This has been attributed to factors such as culture, school location, poverty, pedagogy and many more. The discussion in this article is drawn upon findings from fieldwork study at an Orang Asli village in Johor, Malaysia. This article discusses efforts in raising educational attainment of the Orang Asli through the implementation of the Clusters of Excellence Policy. In so doing it highlights the achievement of the policy and issues surrounding its implementation at the site.

  4. To ventricular assist devices or not: When is implantation of a ventricular assist device appropriate in advanced ambulatory heart failure?

    Science.gov (United States)

    Cerier, Emily; Lampert, Brent C; Kilic, Arman; McDavid, Asia; Deo, Salil V; Kilic, Ahmet

    2016-12-26

    Advanced heart failure has been traditionally treated via either heart transplantation, continuous inotropes, consideration for hospice and more recently via left ventricular assist devices (LVAD). Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure. Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure. The question of when to implant these devices in those patients with advanced, yet still ambulatory heart failure remains a controversial topic. We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.

  5. End-of-Life Decisions and Palliative Care in Advanced Heart Failure.

    Science.gov (United States)

    Meyers, Deborah E; Goodlin, Sarah J

    2016-09-01

    Advanced heart failure (HF) therapies are focused on extending life and improving function. In contrast, palliative care is a holistic approach that focuses on symptom alleviation and patients' physical, psychosocial, and spiritual needs. HF clinicians can integrate palliative care strategies by incorporating several important components of planning and decision-making for HF patients. Future care planning (FCP) for HF patients should incorporate the basic tenets of shared decision-making (SDM). These include understanding the patient's perspective and care preferences, articulating what is medically feasible, and integrating these considerations into the overall care plan. Use of defined triggers for FCP can stimulate important patient-caregiver conversations. Guidelines advocate an annual review of HF status and future care preferences. Advance directives are important for any individual with a chronic, life-limiting illness and should be integrated into FCP. Nevertheless, use of advance directives by HF patients is extremely low. Consideration of illness trajectories and risk-scoring tools might facilitate prognostication and delivery of appropriate HF care. Decisions about heart transplantation or left ventricular assist device implantation should include planning for potential complications associated with these therapies. Such decisions also should include a discussion of palliative management, as an alternative to intervention and also as an option for managing symptoms or adverse events after intervention. Palliative care, including FCP and SDM, should be integrated into the course of all patients with advanced HF. Clinicians who provide HF care should acquire the skills necessary for conducting FCP and SDM discussions.

  6. Patient, carer and professional perspectives on barriers and facilitators to quality care in advanced heart failure.

    Directory of Open Access Journals (Sweden)

    Susan Browne

    Full Text Available BACKGROUND: Those with advanced heart failure (HF experience high levels of morbidity and mortality, similar to common cancers. However, there remains evidence of inequity of access to palliative care services compared to people with cancer. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care. METHODS: Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (n = 30, carers (n = 20, and professionals (n = 65. Data analysed using Normalisation Process Theory (NPT as the underpinning conceptual framework. FINDINGS: Uncertainty is ubiquitous in accounts from advanced HF patients and their caregivers. This uncertainty relates to understanding of the implications of their diagnosis, appropriate treatments, and when and how to seek effective help. Health professionals agree this is a major problem but feel they lack knowledge, opportunities, or adequate support to improve the situation. Fragmented care with lack of coordination and poor communication makes life difficult. Poor understanding of the condition extends to the wider circle of carers and means that requests for help may not be perceived as legitimate, and those with advanced HF are not prioritised for social and financial supports. Patient and caregiver accounts of emergency care are uniformly poor. Managing polypharmacy and enduring concomitant side effects is a major burden, and the potential for rationalisation exists. This study has potential limitations because it was undertaken within a single geographical location within the United Kingdom. CONCLUSIONS: Little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health care services that are poorly coordinated and offer fragmented care. There is evidence that these poor

  7. The acute haemodynamic effect of nebulised frusemide in stable, advanced heart failure.

    Science.gov (United States)

    Newton, Phillip J; Davidson, Patricia M; Krum, Henry; Ollerton, Richard; Macdonald, Peter

    2012-05-01

    To assess the acute haemodynamic effects of nebulised frusemide in a stable advanced heart failure population. In this randomised, double blind, placebo controlled trial, people with stable, advanced heart failure undergoing right heart catheterisation were randomised to receive either 40 mg (4 ml) of nebulised frusemide or 4 ml of normal saline. Following inhalation of the study medication, subjects' pulmonary pressures were recorded every 15 min for 1 h. There were no significant changes in the weighted average time course data of the subjects (n=32) in either group over the study period, in particular no differences were observed in haemodynamic parameters between the two groups. Weighted average pulmonary capillary wedge pressure after 60 min in the frusemide group was 22.5 (SD 6.5) mmHg (n=14) compared to the placebo group's 24.0 (SD 7.3) mmHg (n=18), p=0.55. The frusemide group had a significantly greater change in the median volume of urine in the bladder over the study period (186 ml IQR 137.8-260.8) compared to the placebo group (76 ml IQR 39.0-148.0) p=0.02. This study showed that nebulised frusemide had no significant clinical effect on the haemodynamic characteristics of the subjects. Copyright © 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  8. Failure to Modulate Attentional Control in Advanced Aging Linked to White Matter Pathology

    Science.gov (United States)

    Van Dijk, Koene R. A.; Shire, Emily H.; Sperling, Reisa A.; Johnson, Keith A.; Buckner, Randy L.

    2012-01-01

    Advanced aging is associated with reduced attentional control and less flexible information processing. Here, the origins of these cognitive effects were explored using a functional magnetic resonance imaging task that systematically varied demands to shift attention and inhibit irrelevant information across task blocks. Prefrontal and parietal regions previously implicated in attentional control were recruited by the task and most so for the most demanding task configurations. A subset of older individuals did not modulate activity in frontal and parietal regions in response to changing task requirements. Older adults who did not dynamically modulate activity underperformed their peers and scored more poorly on neuropsychological measures of executive function and speed of processing. Examining 2 markers of preclinical pathology in older adults revealed that white matter hyperintensities (WMHs), but not high amyloid burden, were associated with failure to modulate activity in response to changing task demands. In contrast, high amyloid burden was associated with alterations in default network activity. These results suggest failure to modulate frontal and parietal activity reflects a disruptive process in advanced aging associated with specific neuropathologic processes. PMID:21765181

  9. Heart Transplant and Mechanical Circulatory Support in Patients With Advanced Heart Failure.

    Science.gov (United States)

    Sánchez-Enrique, Cristina; Jorde, Ulrich P; González-Costello, José

    2017-05-01

    Patients with advanced heart failure have a poor prognosis and heart transplant is still the best treatment option. However, the scarcity of donors, long waiting times, and an increasing number of unstable patients have favored the development of mechanical circulatory support. This review summarizes the indications for heart transplant, candidate evaluation, current immunosuppression strategies, the evaluation and treatment of rejection, infectious prophylaxis, and short and long-term outcomes. Regarding mechanical circulatory support, we distinguish between short- and long-term support and the distinct strategies that can be used: bridge to decision, recovery, candidacy, transplant, and destination therapy. We then discuss indications, risk assessment, management of complications, especially with long-term support, and outcomes. Finally, we discuss future challenges and how the widespread use of long-term support for patients with advanced heart failure will only be viable if their complications and costs are reduced. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. submitter CXCL$_{10}$ Is a Circulating Inflammatory Marker in Patients with Advanced Heart Failure: a Pilot Study

    CERN Document Server

    Altara, Raffaele; Hessel, Marleen H; Gu, Yumei; van Vark, Laura C; Akkerhuis, K Martijn; Staessen, Jan A; Struijker-Boudier, Harry A J; Booz, George W; Blankesteijn, W Matthijs

    2016-01-01

    Chemokines are involved in the remodeling of the heart; however, their significance as biomarkers in heart failure is unknown. We observed that circulating CXCR3 receptor chemokines CXCL9 and CXCL10 in a rat model of heart failure were increased 1 week after myocardial infarction. CXCL10 was also increased in both remote and infarcted regions of the heart and remained elevated at 16 weeks; CXCL9 was elevated in the remote area at 1 week. In humans, hierarchical clustering and principal component analysis revealed that circulating CXCL10, MIP-1α, and CD40 ligand were the best indicators for differentiating healthy and heart failure subjects. Serum CXCL10 levels were increased in patients with symptomatic heart failure as indexed by NYHA classification II through IV. The presence of CXCL10, MIP-1α, and CD40 ligand appears to be dominant in patients with advanced heart failure. These findings identify a distinct profile of inflammatory mediators in heart failure patients

  11. An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity.

    Science.gov (United States)

    Hankivsky, Olena; Grace, Daniel; Hunting, Gemma; Giesbrecht, Melissa; Fridkin, Alycia; Rudrum, Sarah; Ferlatte, Olivier; Clark, Natalie

    2014-12-10

    In the field of health, numerous frameworks have emerged that advance understandings of the differential impacts of health policies to produce inclusive and socially just health outcomes. In this paper, we present the development of an important contribution to these efforts - an Intersectionality-Based Policy Analysis (IBPA) Framework. Developed over the course of two years in consultation with key stakeholders and drawing on best and promising practices of other equity-informed approaches, this participatory and iterative IBPA Framework provides guidance and direction for researchers, civil society, public health professionals and policy actors seeking to address the challenges of health inequities across diverse populations. Importantly, we present the application of the IBPA Framework in seven priority health-related policy case studies. The analysis of each case study is focused on explaining how IBPA: 1) provides an innovative structure for critical policy analysis; 2) captures the different dimensions of policy contexts including history, politics, everyday lived experiences, diverse knowledges and intersecting social locations; and 3) generates transformative insights, knowledge, policy solutions and actions that cannot be gleaned from other equity-focused policy frameworks. The aim of this paper is to inspire a range of policy actors to recognize the potential of IBPA to foreground the complex contexts of health and social problems, and ultimately to transform how policy analysis is undertaken.

  12. Advancing the retail endgame: public perceptions of retail policy interventions.

    Science.gov (United States)

    Whyte, Gregor; Gendall, Philip; Hoek, Janet

    2014-03-01

    Evidence that exposure to tobacco 'powerwalls' increases young people's susceptibility to smoking has led many countries to require the removal of these displays. Despite this important step, tobacco remains widely available and policy action appears to have stalled. We conducted an online survey of 364 smokers and 402 non-smokers aged 18 years and above, who were sampled from a commercial internet panel in January 2013. Six months after the removal of all tobacco products from open display in New Zealand retail outlets, strong support for the new law exists. Although daily smokers were less supportive than other groups, smokers intending to quit within the next 6 months were more likely than not to believe the law would facilitate quitting. Irrespective of their smoking status, respondents supported not selling tobacco products within 500 m of a school, and requiring tobacco retailers to sell nicotine replacement therapy products. Public support for more progressive 'endgame' retail measures could catalyse policy action which, in turn, could offer greater protection to young people and accelerate declines in smoking prevalence. Mandatory tobacco-free retail zones around schools, and requiring stores selling tobacco to stock cessation products received strong support, even among daily smokers; both measures would reduce youth exposure to tobacco while providing smokers with better access to cessation aids.

  13. Living with an unfixable heart: a qualitative study exploring the experience of living with advanced heart failure.

    LENUS (Irish Health Repository)

    Ryan, Marie

    2012-02-01

    BACKGROUND: Nurses working with patients with advanced heart failure need knowledge that will help us to help patients cope with their situations of chronic illness. However, our knowledge bank is deficient due to the scarcity of inquiry that takes the affected person\\'s point of view as its central focus. AIM: The aim of this study was to describe patients\\' experiences of living with advanced heart failure. METHODS: The study sample (N=9) consisted of male (N=6) and female (N=3) patients with advanced (NYHA classes III-IV) heart failure. The design was qualitative and open unstructured interviews were audio-taped and transcribed verbatim during 2006. RESULTS: Four main themes emerged: Living in the Shadow of Fear; Running on Empty; Living a Restricted life; and Battling the System. The experience of living with advanced heart failure was described as a fearful and tired sort of living characterised by escalating impotence and dependence. CONCLUSIONS: The findings suggest that there may be an illogical but enduring ethos of \\'cure\\' pervading health care worker\\'s attitudes to advanced heart failure care. This mindset might be working to hinder the application of additional or alternative therapies, which might better palliate the physical and psychosocial distress of patients.

  14. Discerning and Addressing Environmental Failures in Policy Scenarios Using Planning Support System (PSS Technologies

    Directory of Open Access Journals (Sweden)

    Brian Deal

    2016-12-01

    Full Text Available The environmental consequences of planning decisions are often undervalued. This can result from a number of potential causes: (a there might be a lack of adequate information to correctly assess environmental consequences; (b stakeholders might discount the spatial and temporal impacts; (c a failure to understand the dynamic interactions between socio-ecological systems including secondary and tertiary response mechanisms; or (d the gravity of the status quo, i.e., blindly following a traditional discourse. In this paper, we argue that a Planning Support System (PSS that enhances an assessment of environmental impacts and is integral to a community or regional planning process can help reveal the true environmental implications of scenario planning decisions, and thus improve communal planning and decision-making. We demonstrate our ideas through our experiences developing and deploying one such PSS—the Land-use Evolution and impact Assessment Model (LEAM Planning Support System. University of Illinois researchers have worked directly with government planning officials and community stakeholders to analyze alternate future development scenarios and improve the planning process through a participatory, iterative process of visioning, model tuning, simulation, and discussion. The resulting information enables an evaluation of alternative policy or investment choices and their potential environmental implications that can change the way communities both generate and use plans.

  15. A periodic inspection and replacement policy for systems subject to competing failure modes due to degradation and traumatic events

    Energy Technology Data Exchange (ETDEWEB)

    Huynh, K.T., E-mail: tuan.huynh@utt.f [Universite de technologie de Troyes, Institut Charles Delaunay and STMR UMR CNRS 6279-12, rue Marie Curie, BP2060, 10010 Troyes cedex (France); Barros, A., E-mail: anne.barros@utt.f [Universite de technologie de Troyes, Institut Charles Delaunay and STMR UMR CNRS 6279-12, rue Marie Curie, BP2060, 10010 Troyes cedex (France); Berenguer, C., E-mail: christophe.berenguer@utt.f [Universite de technologie de Troyes, Institut Charles Delaunay and STMR UMR CNRS 6279-12, rue Marie Curie, BP2060, 10010 Troyes cedex (France); Castro, I.T., E-mail: inmatorres@unex.e [Departamento de Matematicas, Escuela Politecnica, 10071 Caceres (Spain)

    2011-04-15

    This paper deals with the condition-based maintenance of single-unit systems which are subject to the competing and dependent failures due deterioration and traumatic shock events. The main aim is to provide a model to assess the value of condition monitoring information for the maintenance decision-making. A condition-based periodic inspection/replacement policy is developed and compared with a benchmark time-based block replacement policy. Numerical results show that it is indeed useful to follow closely the actual evolution of the system to adapt the maintenance decisions to the true system state to improve the performance of maintenance policies. The analysis of the maintenance costs savings can be used to justify or not the choice to implement a policy based on condition monitoring information and to invest in condition monitoring devices.

  16. Symptom clusters and quality of life among patients with advanced heart failure.

    Science.gov (United States)

    Yu, Doris Sf; Chan, Helen Yl; Leung, Doris Yp; Hui, Elsie; Sit, Janet Wh

    2016-07-01

    To identify symptom clusters among patients with advanced heart failure (HF) and the independent relationships with their quality of life (QoL). This is the secondary data analysis of a cross-sectional study which interviewed 119 patients with advanced HF in the geriatric unit of a regional hospital in Hong Kong. The symptom profile and QoL were assessed by using the Edmonton Symptom Assessment Scale (ESAS) and the McGill QoL Questionnaire. Exploratory factor analysis was used to identify the symptom clusters. Hierarchical regression analysis was used to examine the independent relationships with their QoL, after adjusting the effects of age, gender, and comorbidities. The patients were at an advanced age (82.9 ± 6.5 years). Three distinct symptom clusters were identified: they were the distress cluster (including shortness of breath, anxiety, and depression), the decondition cluster (fatigue, drowsiness, nausea, and reduced appetite), and the discomfort cluster (pain, and sense of generalized discomfort). These three symptom clusters accounted for 63.25% of variance of the patients' symptom experience. The small to moderate correlations between these symptom clusters indicated that they were rather independent of one another. After adjusting the age, gender and comorbidities, the distress (β = -0.635, P < 0.001), the decondition (β = -0.148, P = 0.01), and the discomfort (β = -0.258, P < 0.001) symptom clusters independently predicted their QoL. This study identified the distinctive symptom clusters among patients with advanced HF. The results shed light on the need to develop palliative care interventions for optimizing the symptom control for this life-limiting disease.

  17. A Review of Failure Analysis Methods for Advanced 3D Microelectronic Packages

    Science.gov (United States)

    Li, Yan; Srinath, Purushotham Kaushik Muthur; Goyal, Deepak

    2016-01-01

    Advanced three dimensional (3D) packaging is a key enabler in driving form factor reduction, performance benefits, and package cost reduction, especially in the fast paced mobility and ultraportable consumer electronics segments. The high level of functional integration and the complex package architecture pose a significant challenge for conventional fault isolation (FI) and failure analysis (FA) methods. Innovative FI/FA tools and techniques are required to tackle the technical and throughput challenges. In this paper, the applications of FI and FA techniques such as Electro Optic Terahertz Pulse Reflectometry, 3D x-ray computed tomography, lock-in thermography, and novel physical sample preparation methods to 3D packages with package on package and stacked die with through silicon via configurations are reviewed, along with the key FI and FA challenges.

  18. Simulations of Failure via Three-Dimensional Cracking in Fuel Cladding for Advanced Nuclear Fuels

    Energy Technology Data Exchange (ETDEWEB)

    Lu, Hongbing [Univ. of Texas, Austin, TX (United States); Bukkapatnam, Satish; Harimkar, Sandip; Singh, Raman; Bardenhagen, Scott

    2014-01-09

    Enhancing performance of fuel cladding and duct alloys is a key means of increasing fuel burnup. This project will address the failure of fuel cladding via three-dimensional cracking models. Researchers will develop a simulation code for the failure of the fuel cladding and validate the code through experiments. The objective is to develop an algorithm to determine the failure of fuel cladding in the form of three-dimensional cracking due to prolonged exposure under varying conditions of pressure, temperature, chemical environment, and irradiation. This project encompasses the following tasks: 1. Simulate 3D crack initiation and growth under instantaneous and/or fatigue loads using a new variant of the material point method (MPM); 2. Simulate debonding of the materials in the crack path using cohesive elements, considering normal and shear traction separation laws; 3. Determine the crack propagation path, considering damage of the materials incorporated in the cohesive elements to allow the energy release rate to be minimized; 4. Simulate the three-dimensional fatigue crack growth as a function of loading histories; 5. Verify the simulation code by comparing results to theoretical and numerical studies available in the literature; 6. Conduct experiments to observe the crack path and surface profile in unused fuel cladding and validate against simulation results; and 7. Expand the adaptive mesh refinement infrastructure parallel processing environment to allow adaptive mesh refinement at the 3D crack fronts and adaptive mesh merging in the wake of cracks. Fuel cladding is made of materials such as stainless steels and ferritic steels with added alloying elements, which increase stability and durability under irradiation. As fuel cladding is subjected to water, chemicals, fission gas, pressure, high temperatures, and irradiation while in service, understanding performance is essential. In the fast fuel used in advanced burner reactors, simulations of the nuclear

  19. Aortic Counterpulsation Therapy in Patients with Advanced Heart Failure: Analysis of the TBRIDGE Registry

    Directory of Open Access Journals (Sweden)

    Cristiano Guedes Bezerra

    2016-01-01

    Full Text Available Abstract Background: The use of aortic counterpulsation therapy in advanced heart failure is controversial. Objectives: To evaluate the hemodynamic and metabolic effects of intra-aortic balloon pump (IABP and its impact on 30-day mortality in patients with heart failure. Methods: Historical prospective, unicentric study to evaluate all patients treated with IABP betwen August/2008 and July/2013, included in an institutional registry named TBRIDGE (The Brazilian Registry of Intra-aortic balloon pump in Decompensated heart failure - Global Evaluation. We analyzed changes in oxygen central venous saturation (ScvO2, arterial lactate, and use of vasoactive drugs at 48 hours after IABP insertion. The 30-day mortality was estimated by the Kaplan-Meier method and diferences in subgroups were evaluated by the Log-rank test. Results: A total of 223 patients (mean age 49 ± 14 years were included. Mean left ventricle ejection fraction was 24 ± 10%, and 30% of patients had Chagas disease. Compared with pre-IABP insertion, we observed an increase in ScvO2 (50.5% vs. 65.5%, p < 0.001 and use of nitroprusside (33.6% vs. 47.5%, p < 0.001, and a decrease in lactate levels (31.4 vs. 16.7 mg/dL, p < 0.001 and use of vasopressors (36.3% vs. 25.6%, p = 0.003 after IABP insertion. Thirty-day survival was 69%, with lower mortality in Chagas disease patients compared without the disease (p = 0.008. Conclusion: After 48 hours of use, IABP promoted changes in the use of vasoactive drugs, improved tissue perfusion. Chagas etiology was associated with lower 30-day mortality. Aortic counterpulsation therapy is an effective method of circulatory support for patients waiting for heart transplantation.

  20. Advancing team-based primary health care: a comparative analysis of policies in western Canada.

    Science.gov (United States)

    Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T

    2017-07-17

    We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.

  1. Investigation of the Failure of Advanced High Strength Steels Heterogeneous Spot Welds

    Directory of Open Access Journals (Sweden)

    Thibaut Huin

    2016-05-01

    Full Text Available Nowadays, environmental regulation encourages carmakers to reduce the global vehicle weight. Steelmakers develop grades with high performance (Advanced High Strength Steels, AHSS and fine steel sheet assemblies are used in car body structures, with an optimized thickness in each part. However, unusual fracture modes are sometimes observed during the mechanical tests of heterogeneous AHSS welds, made of dissimilar steel grades and sheet thicknesses. Weld fractures can occur with a strength lower than expected. This study aims at understanding these fracture mechanisms and focuses on two common steel grades joined by Resistance Spot Welding (RSW: DP600 (a dual phase steel and Usibor®1500 (a martensitic steel. The parameters affecting the failure modes and load bearing capacity are investigated during two common types of tests: the Cross Tension and Tensile Shear tests. The positive effects of heterogeneous welding with respect to the corresponding homogeneous configurations are discussed, as well as the consequences of a so-called Dome failure occurring at the weld nugget boundary.

  2. Dosage of angiotensin-II receptor blockers in heart failure patients following changes in Danish drug reimbursement policies

    DEFF Research Database (Denmark)

    Selmer, Christian; Lamberts, Morten; Kristensen, Søren Lund;

    2014-01-01

    PURPOSE: National reimbursement policies in Denmark were changed in November 2010 favouring a shift in angiotensin-II receptor blocker (ARB) treatment to generic losartan for heart failure (HF) patients. We examined how changes in reimbursement policies affected the fraction of HF patients up-tit......), compared with May-Jul 2010 (reference). CONCLUSION: Probability of being up-titrated in ARB treatment was reduced 20% following changes in drug reimbursement policies.......PURPOSE: National reimbursement policies in Denmark were changed in November 2010 favouring a shift in angiotensin-II receptor blocker (ARB) treatment to generic losartan for heart failure (HF) patients. We examined how changes in reimbursement policies affected the fraction of HF patients up....... Individual-level linkage of nationwide registries of hospitalization and drug dispensing in Denmark was used to describe patterns of ARB prescriptions and estimate dosage before and after November 2010. Logistic regression models were used to assess the probability for being up-titrated in the period...

  3. A Korean perspective on developing a global policy for advance directives.

    Science.gov (United States)

    Kim, Soyoon; Hahm, Ki-Hyun; Park, Hyoung Wook; Kang, Hyun Hee; Sohn, Myongsei

    2010-03-01

    Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible.

  4. Career cartography: a conceptualization of career development to advance health and policy.

    Science.gov (United States)

    Feetham, Suzanne; Doering, Jennifer J

    2015-01-01

    The purpose of this article is to propose a conceptualization of career development that emphasizes the interdependence between research, practice, and policy. Career cartography applies three decades of career development experience to lay out a systematic, comprehensive, and iterative approach for planning and communicating the outcomes of science at any career stage. To inform practice and policy, nurse researchers must be clear on the intended destination and trajectory of the science, and be skilled in communicating that science and vision to diverse stakeholders. Career cartography builds on the science of cartography, is developed within the context of public and health policy, and is composed of several components, including a destination statement, career mapping, a supportive career cartography team, and use of communication and dissemination strategies. The successful utilization of career cartography may accelerate advancement of individual careers, scientific impact, and the discipline as a whole by guiding nurse researchers to be deliberative in career planning and to communicate successfully the outcomes of research across a wide variety of stakeholders. Career cartography provides a framework for planning a nurse researcher's program of research and scholarship to advance science, policy, and health of the public. Career cartography guides nurse researchers to realize their full potential to advance the health of the public and inform public and health policy in academic and practice environments. © 2014 Sigma Theta Tau International.

  5. Advanced Technological Education (ATE) Program: Building a Pipeline of Skilled Workers. Policy Brief

    Science.gov (United States)

    American Youth Policy Forum, 2010

    2010-01-01

    In the Fall of 2008, the American Youth Policy Forum hosted a series of three Capitol Hill forums showcasing the Advanced Technological Education (ATE) program supported by the National Science Foundation (NSF). The goal of these forums was to educate national policymakers about the importance of: (1) improving the science and math competencies of…

  6. Advances in Financial Risk Management and Economic Policy Uncertainty: An Overview

    NARCIS (Netherlands)

    S.M. Hammoudeh (Shawkat); M.J. McAleer (Michael)

    2014-01-01

    markdownabstract__Abstract__ Financial risk management is difficult at the best of times, but especially so in the presence of economic uncertainty and financial crises. The purpose of this special issue on “Advances in Financial Risk Management and Economic Policy Uncertainty” is to highlight some

  7. Refeeding syndrome in a patient with advanced kidney failure due to nephronophthisis.

    Science.gov (United States)

    El-Reshaid, Kamel

    2013-11-01

    Refeeding syndrome (RS) is a serious and potentially fatal disorder. It is caused by a shift of fluids, sodium, potassium, magnesium and phosphorus as well changes in the metabolism of glucose, protein, fat and vitamins following the refeeding of malnourished patients, whether enterally or parenterally. RS has rarely been reported in patients with advanced kidney disease probably due to the pre-existing hyperphosphatemia, hypermagnesemia and hyperkalemia in these patients. In the following report, we present a patient with nephronophthisis type 1 deletion syndrome in whom her main previous nutrition was limited to simply rehydration to avoid renal replacement therapy. On presentation, she was cachectic and dehydrated with advanced kidney failure. She was treated with medical nephrectomy using non-steroidal anti-inflammatory drugs and then placed on maintenance hemodialysis. Percutaneous endoscopic gastrostomy was used for her initial feeding. Care was exercised during her early refeeding with regard to correction of fluids and essential electrolytes, viz. potassium, phosphorus and magnesium, as well as multivitamins to avoid the cardiovascular and neurological complications of RS. However, the changes in the gut, pancreas and liver as well as her hyperlipidemia were a clear obstacle. Fortunately, the ileus and pancreatitis she developed on refeeding improved dramatically with a decrease of the feeding dose to half; however, the liver abnormalities and hyperlipidemia were severe and slow to recover. These improved after addition of ursodeoxycholic acid and permitted successful increase of the dose of feeding subsequently.

  8. Refeeding syndrome in a patient with advanced Kidney failure due to Nephronophthisis

    Directory of Open Access Journals (Sweden)

    Kamel El-Reshaid

    2013-01-01

    Full Text Available Refeeding syndrome (RS is a serious and potentially fatal disorder. It is caused by a shift of fluids, sodium, potassium, magnesium and phosphorus as well changes in the metabolism of glucose, protein, fat and vitamins following the refeeding of malnourished patients, whether enterally or parenterally. RS has rarely been reported in patients with advanced kidney disease probably due to the pre-existing hyperphosphatemia, hypermagnesemia and hyperkalemia in these patients. In the following report, we present a patient with nephronophthisis type 1 deletion syndrome in whom her main previous nutrition was limited to simply rehydration to avoid renal replacement therapy. On presentation, she was cachectic and dehydrated with advanced kidney failure. She was treated with medical nephrectomy using non-steroidal anti-inflammatory drugs and then placed on maintenance hemodialysis. Percutaneous endoscopic gastrostomy was used for her initial feeding. Care was exercised during her early refeeding with regard to correction of fluids and essential electrolytes, viz. potassium, phosphorus and magnesium, as well as multivitamins to avoid the cardiovascular and neurological complications of RS. However, the changes in the gut, pancreas and liver as well as her hyperlipidemia were a clear obstacle. Fortunately, the ileus and pancreatitis she developed on refeeding improved dramatically with a decrease of the feeding dose to half; however, the liver abnormalities and hyperlipidemia were severe and slow to recover. These improved after addition of ursodeoxycholic acid and permitted successful increase of the dose of feeding subsequently.

  9. Developing public policy to advance the use of big data in health care.

    Science.gov (United States)

    Heitmueller, Axel; Henderson, Sarah; Warburton, Will; Elmagarmid, Ahmed; Pentland, Alex Sandy; Darzi, Ara

    2014-09-01

    The vast amount of health data generated and stored around the world each day offers significant opportunities for advances such as the real-time tracking of diseases, predicting disease outbreaks, and developing health care that is truly personalized. However, capturing, analyzing, and sharing health data is difficult, expensive, and controversial. This article explores four central questions that policy makers should consider when developing public policy for the use of "big data" in health care. We discuss what aspects of big data are most relevant for health care and present a taxonomy of data types and levels of access. We suggest that successful policies require clear objectives and provide examples, discuss barriers to achieving policy objectives based on a recent policy experiment in the United Kingdom, and propose levers that policy makers should consider using to advance data sharing. We argue that the case for data sharing can be won only by providing real-life examples of the ways in which it can improve health care.

  10. Hospice Enrollment in Patients With Advanced Heart Failure Decreases Acute Medical Service Utilization.

    Science.gov (United States)

    Yim, Cindi K; Barrón, Yolanda; Moore, Stanley; Murtaugh, Chris; Lala, Anuradha; Aldridge, Melissa; Goldstein, Nathan; Gelfman, Laura P

    2017-03-01

    Patients with advanced heart failure (HF) enroll in hospice at low rates, and data on their acute medical service utilization after hospice enrollment is limited. We performed a descriptive analysis of Medicare fee-for-service beneficiaries, with at least one home health claim between July 1, 2009, and June 30, 2010, and at least 2 HF hospitalizations between July 1, 2009, and December 31, 2009, who subsequently enrolled in hospice between July 1, 2009, and December 31, 2009. We estimated panel-negative binomial models on a subset of beneficiaries to compare their acute medical service utilization before and after enrollment. Our sample size included 5073 beneficiaries: 55% were female, 45% were ≥85 years of age, 13% were non-white, and the mean comorbidity count was 2.38 (standard deviation 1.22). The median number of days between the second HF hospital discharge and hospice enrollment was 45. The median number of days enrolled in hospice was 15, and 39% of the beneficiaries died within 7 days of enrollment. During the study period, 11% of the beneficiaries disenrolled from hospice at least once. The adjusted mean number of hospital, intensive care unit, and emergency room admissions decreased from 2.56, 0.87, and 1.17 before hospice enrollment to 0.53, 0.19, and 0.76 after hospice enrollment. Home health care Medicare beneficiaries with advanced HF who enrolled in hospice had lower acute medical service utilization after their enrollment. Their pattern of hospice use suggests that earlier referral and improved retention may benefit this population. Further research is necessary to understand hospice referral and palliative care needs of advanced HF patients. © 2017 American Heart Association, Inc.

  11. The Failure of ECB Monetary Policy from a Mises-Hayek Perspective

    OpenAIRE

    Schnabl, Gunther

    2017-01-01

    The paper analyses the common European monetary policy based on a Mises-Hayek overinvestment framework, which is combined with the theory of optimum currency areas. It shows how since the turn of the millennium a too expansionary monetary policy contributed to unsustainable overinvestment booms in the periphery of the European Monetary Union, and more recently in Germany, dependent on the national fiscal policy stances. It is argued that the ECB´s ultra-loose monetary policy as a crisis thera...

  12. Myostatin signaling is up-regulated in female patients with advanced heart failure.

    Science.gov (United States)

    Ishida, Junichi; Konishi, Masaaki; Saitoh, Masakazu; Anker, Markus; Anker, Stefan D; Springer, Jochen

    2017-07-01

    Myostatin, a negative regulator of skeletal muscle mass, is up-regulated in the myocardium of heart failure (HF) and increased myostatin is associated with weight loss in animal models with HF. Although there are disparities in pathophysiology and epidemiology between male and female patients with HF, it remains unclear whether there is gender difference in myostatin expression and whether it is associated with weight loss in HF patients. Heart tissue samples were collected from patients with advanced heart failure (n=31, female n=5) as well as healthy control donors (n=14, female n=6). Expression levels of myostatin and its related proteins in the heart were evaluated by western blotting analysis. Body mass index was significantly lower in female HF patients than in male counterparts (20.0±4.2 in female vs 25.2±3.8 in male, p=0.04). In female HF patients, both mature myostatin and pSmad2 were significantly up-regulated by 1.9 fold (p=0.05) and 2.5 fold (p<0.01) respectively compared to female donors, while expression of pSmad2 was increased by 2.8 times in male HF patients compared to male healthy subjects, but that of myostatin was not. There was no significant difference in protein expression related to myostatin signaling between male and female patients. In this study, myostatin and pSmad2 were significantly up-regulated in the failing heart of female patients, but not male patients, and female patients displayed lower body mass index. Enhanced myostatin signaling in female failing heart may causally contribute to pathogenesis of HF and cardiac cachexia. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Tissue advanced glycation end products are associated with diastolic function and aerobic exercise capacity in diabetic heart failure patients

    NARCIS (Netherlands)

    Willemsen, Suzan; Hartog, Jasper W. L.; Hummel, Yoran M.; van Ruijven, Marieke H. I.; van der Horst, Iwan C. C.; van Veldhuisen, Dirk J.; Voors, Adriaan A.

    2011-01-01

    Aims Advanced glycation end products (AGEs) are increased in patients with diabetes and are associated with diastolic dysfunction through the formation of collagen crosslinks in the heart. The association among AGEs, diastolic function, and aerobic capacity in heart failure (HF) patients with and wi

  14. Qt dispersion has no prognostic information for patients with advanced congestive heart failure and reduced left ventricular systolic function

    DEFF Research Database (Denmark)

    Brendorp, B; Elming, H; Jun, L;

    2001-01-01

    BACKGROUND: QT dispersion is a potential prognostic marker of tachyarrhythmic events and death, but it is unclear whether this applies to patients with congestive heart failure (CHF). METHODS AND RESULTS: Of the 1518 patients with advanced CHF and left ventricular dysfunction enrolled in the Danish...

  15. Implantation of an Andrastent XL in an adult with advanced chronic heart failure due to coarctation of the aorta.

    Science.gov (United States)

    Białkowski, Jacek; Szkutnik, Małgorzata; Fiszer, Roland; Wolny, Tomasz; Knapik, Tomasz; Nowalany-Kozielska, Ewa; Zembala, Marian

    2011-01-01

    We report the case of a 49 year-old-man with congenital coarctation of the aorta (CoA), admitted in a critical clinical condition due to advanced secondary cardiomyopathy and chronic heart failure. An Andrastent XL was implanted successfully in the CoA. The procedure resulted in an almost completely resolved CoA and prompt clinical improvement in the patient.

  16. Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

    Science.gov (United States)

    George, Susan; Leasure, A Renee

    2016-01-01

    Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.

  17. On the inspection policy of a two-component parallel system with failure interaction

    Energy Technology Data Exchange (ETDEWEB)

    Zequeira, Romulo I. [ISTIT, Equipe Modelisation et Surete des Systemes, Universite de Technologie de Troyes, 12 Rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: romulo.zequeira@utt.fr; Berenguer, Christophe [ISTIT, Equipe Modelisation et Surete des Systemes, Universite de Technologie de Troyes, 12 Rue Marie Curie, BP 2060, 10010 Troyes Cedex (France)]. E-mail: christophe.berenguer@utt.fr

    2005-04-01

    In this paper we study a two-component standby system which can successfully operate upon a demand if at least one component is not failed. We assume that failures can be detected only by periodic inspections. We consider that the failure of one component can modify the (conditional) failure probability of the component still alive with probability p and do not interact with probability 1-p. For that failure interaction scheme we obtain the system reliability function for the case of staggered inspections. We compare staggered and non-staggered inspections through numerical examples considering constant hazard rates.

  18. Evaluation of Resting Cardiac Power Output as a Prognostic Factor in Patients with Advanced Heart Failure.

    Science.gov (United States)

    Yildiz, Omer; Aslan, Gamze; Demirozu, Zumrut T; Yenigun, Cemal Deniz; Yazicioglu, Nuran

    2017-09-15

    If the heart is represented by a hydraulic pump, cardiac power represents the hydraulic function of the heart. Cardiac pump function is frequently determined through left ventricular ejection fraction using imaging. This study aims to validate resting cardiac power output (CPO) as a predictive biomarker in patients with advanced heart failure (HF). One hundred and seventy-two patients with HF severe enough to warrant cardiac transplantation were retrospectively reviewed at a single tertiary care institution between September 2010 and July 2013. Patients were initially evaluated with simultaneous right-sided and left-sided cardiac catheter-based hemodynamic measurements, followed by longitudinal follow-up (median of 52 months) for adverse events (cardiac mortality, cardiac transplantation, or ventricular assist device placement). Median resting CPO was 0.54 W (long rank chi-square = 33.6; p < 0.0001). Decreased resting CPO (<0.54 W) predicted increased risk for adverse outcomes. Fifty cardiac deaths, 10 cardiac transplants, and 12 ventricular assist device placements were documented. The prognostic relevance of resting CPO remained significant after adjustment for age, gender, left ventricular ejection fraction, mean arterial pressure, pulmonary vascular resistance, right atrial pressure, and estimated glomerular filtration rate (HR, 3.53; 95% confidence interval, 1.66 to 6.77; p = 0.0007). In conclusion, lower resting CPO supplies independent prediction of adverse outcomes. Thus, it could be effectively used for risk stratification in patients with advanced HF. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. [Treatment of advanced heart failure in women: heart transplantation and ventricular assist devices].

    Science.gov (United States)

    Cipriani, Manlio; Macera, Francesca; Verde, Alessandro; Bruschi, Giuseppe; del Medico, Marta; Oliva, Fabrizio; Martinelli, Luigi; Frigerio, Maria

    2012-05-01

    Women candidates for heart transplantation are definitely less than men, just 20% of all patients transplanted; even in the INTERMACS registry they represent only 21% of all ventricular assist devices (VAD) implanted. The reasons for this big difference are discussed in this article. Why women are less frequently assessed for unconventional therapies? Are they sicker or just less regarded? Our experience and the literature show us clear epidemiological, clinical and treatment differences that could lead to a lower prevalence of end-stage disease in women of an age suitable for unconventional therapies. Once on the transplant list, women wait less than men for a heart transplant, because they present with more severe disease, have a lower body mass index and undergo less VAD implants. After transplantation women's survival is comparable to men's, although they usually complain of a lower quality of life. Females receive less often a VAD than men. The main reasons for this include presentation with advanced heart failure at an older age than men, worse outcomes related to small body surface area, and lower survival rates on VAD when implanted as bridge to heart transplantation.

  20. Successes and failures in the control of infectious diseases in Brazil: social and environmental context, policies, interventions, and research needs.

    Science.gov (United States)

    Barreto, Mauricio L; Teixeira, M Gloria; Bastos, Francisco I; Ximenes, Ricardo A A; Barata, Rita B; Rodrigues, Laura C

    2011-05-28

    Despite pronounced reductions in the number of deaths due to infectious diseases over the past six decades, infectious diseases are still a public health problem in Brazil. In this report, we discuss the major successes and failures in the control of infectious diseases in Brazil, and identify research needs and policies to further improve control or interrupt transmission. Control of diseases such as cholera, Chagas disease, and those preventable by vaccination has been successful through efficient public policies and concerted efforts from different levels of government and civil society. For these diseases, policies dealt with key determinants (eg, the quality of water and basic sanitation, vector control), provided access to preventive resources (such as vaccines), and successfully integrated health policies with broader social policies. Diseases for which control has failed (such as dengue fever and visceral leishmaniasis) are vector-borne diseases with changing epidemiological profiles and major difficulties in treatment (in the case of dengue fever, no treatment is available). Diseases for which control has been partly successful have complex transmission patterns related to adverse environmental, social, economic, or unknown determinants; are sometimes transmitted by insect vectors that are difficult to control; and are mostly chronic diseases with long infectious periods that require lengthy periods of treatment.

  1. A portfolio approach to evaluating natural hazard mitigation policies: An Application to lateral-spread ground failure in Coastal California

    Science.gov (United States)

    Bernknopf, R.L.; Dinitz, L.B.; Rabinovici, S.J.M.; Evans, A.M.

    2001-01-01

    In the past, efforts to prevent catastrophic losses from natural hazards have largely been undertaken by individual property owners based on site-specific evaluations of risks to particular buildings. Public efforts to assess community vulnerability and encourage mitigation have focused on either aggregating site-specific estimates or adopting standards based upon broad assumptions about regional risks. This paper develops an alternative, intermediate-scale approach to regional risk assessment and the evaluation of community mitigation policies. Properties are grouped into types with similar land uses and levels of hazard, and hypothetical community mitigation strategies for protecting these properties are modeled like investment portfolios. The portfolios consist of investments in mitigation against the risk to a community posed by a specific natural hazard, and are defined by a community's mitigation budget and the proportion of the budget invested in locations of each type. The usefulness of this approach is demonstrated through an integrated assessment of earthquake-induced lateral-spread ground failure risk in the Watsonville, California area. Data from the magnitude 6.9 Loma Prieta earthquake of 1989 are used to model lateral-spread ground failure susceptibility. Earth science and economic data are combined and analyzed in a Geographic Information System (GIS). The portfolio model is then used to evaluate the benefits of mitigating the risk in different locations. Two mitigation policies, one that prioritizes mitigation by land use type and the other by hazard zone, are compared with a status quo policy of doing no further mitigation beyond that which already exists. The portfolio representing the hazard zone rule yields a higher expected return than the land use portfolio does: However, the hazard zone portfolio experiences a higher standard deviation. Therefore, neither portfolio is clearly preferred. The two mitigation policies both reduce expected losses

  2. An Exploration of Advanced Distributed Learning Service Success Measures for Social Policy

    Science.gov (United States)

    2009-04-01

    System and Navy eLearning should be sought and made available. In addition, three existing concepts, already being used in other Air Force arenas, are...color images. 14. ABSTRACT Since the turn of the century, the military has leveraged computer networks and online media to modernize its training...training system , the Advanced Distributed Learning Service (ADLS), to train and track a number of social policy topics such as the Law of Armed Conflict

  3. Evaluating Forecasts, Narratives and Policy Using a Test of Invariance

    Directory of Open Access Journals (Sweden)

    Jennifer L. Castle

    2017-09-01

    Full Text Available Economic policy agencies produce forecasts with accompanying narratives, and base policy changes on the resulting anticipated developments in the target variables. Systematic forecast failure, defined as large, persistent deviations of the outturns from the numerical forecasts, can make the associated narrative false, which would in turn question the validity of the entailed policy implementation. We establish when systematic forecast failure entails failure of the accompanying narrative, which we call forediction failure, and when that in turn implies policy invalidity. Most policy regime changes involve location shifts, which can induce forediction failure unless the policy variable is super exogenous in the policy model. We propose a step-indicator saturation test to check in advance for invariance to policy changes. Systematic forecast failure, or a lack of invariance, previously justified by narratives reveals such stories to be economic fiction.

  4. Appropriateness of medications prescribed to elderly patients with advanced heart failure and limited life expectancy who died during hospitalization.

    Science.gov (United States)

    Barceló, Montserrat; Torres, Olga; Ruiz, Domingo; Casademont, Jordi

    2014-07-01

    Drug therapy in patients with advanced heart failure and limited life expectancy may be of no benefit or even inappropriate. The aim of this study was to analyze the appropriateness of medication prescribed to patients with advanced heart failure and limited life expectancy, considering as such an expected median survival of less than 6 months. We retrospectively reviewed data on all patients with advanced heart failure who met criteria for limited life expectancy and who died in the geriatric ward of a tertiary hospital over a four-and-a-half-year period. We analyzed treatments prescribed before admission, especially drugs used for prophylaxis or to prolong life. A total of 72 patients were included. The mean age was 85.4 years, and 52.3 % were women. Mean Charlson index was 3.2. Prophylactic medications taken by patients at admission were antiplatelets in 40 patients (55.6 %), oral anticoagulants in 17 (23.6 %), statins in 14 (19.4 %), and osteoporosis medication in nine (12.5 %). Medications taken to prolong survival were angiotensin converting enzyme inhibitors or angiotensin II receptor antagonists in 29 patients (40.3 %). Other medications were iron supplements in 19 patients (26.4 %), vitamins in two (2.8 %), and acetylcholinesterase inhibitors in two (2.8 %). Our results show that patients with advanced heart failure and limited life expectancy were receiving an excessive number of prophylactic medications, drugs to prolong life, and other inappropriate treatments. These findings emphasize the need to review drug therapy in an individualized manner in elderly patients with advanced stages of heart disease and a poor prognosis.

  5. Advance care planning for nursing home residents with dementia: Influence of 'we DECide' on policy and practice.

    Science.gov (United States)

    Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal

    2017-01-01

    (1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Nature as capital: Advancing and incorporating ecosystem services in United States federal policies and programs.

    Science.gov (United States)

    Schaefer, Mark; Goldman, Erica; Bartuska, Ann M; Sutton-Grier, Ariana; Lubchenco, Jane

    2015-06-16

    The concept of nature as capital is gaining visibility in policies and practices in both the public and private sectors. This change is due to an improved ability to assess and value ecosystem services, as well as to a growing recognition of the potential of an ecosystem services approach to make tradeoffs in decision making more transparent, inform efficient use of resources, enhance resilience and sustainability, and avoid unintended negative consequences of policy actions. Globally, governments, financial institutions, and corporations have begun to incorporate natural capital accounting in their policies and practices. In the United States, universities, nongovernmental organizations, and federal agencies are actively collaborating to develop and apply ecosystem services concepts to further national environmental and economic objectives. Numerous federal agencies have begun incorporating these concepts into land use planning, water resources management, and preparations for, and responses to, climate change. Going forward, well-defined policy direction will be necessary to institutionalize ecosystem services approaches in federal agencies, as well as to guide intersector and interdisciplinary collaborative research and development efforts. In addition, a new generation of decision support tools are needed to further the practical application of ecosystem services principles in policymaking and commercial activities. Improved performance metrics are needed, as are mechanisms to monitor the status of ecosystem services and assess the environmental and economic impacts of policies and programs. A greater national and international financial commitment to advancing ecosystem services and natural capital accounting would likely have broad, long-term economic and environmental benefits.

  7. The National Strategic Plan of South Africa: what are the prospects of success after the repeated failure of previous AIDS policy?

    Science.gov (United States)

    Wouters, Edwin; van Rensburg, H C J; Meulemans, H

    2010-05-01

    Hitherto, the story of HIV/AIDS in South Africa is, to a large extent, one of lost opportunities. Whereas the country has one of the worst epidemics in the world, consecutive national AIDS strategies have been repeatedly marked by failure over almost three decades. Understandably, South Africa's most recent HIV/AIDS policy, the HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011 (NSP), has been greeted with general acclaim. However, what are its real prospects of success against the backdrop of the repeated failures of the past? The first objective of this review is to systematically identify the core reasons for past policy failures. Using a comprehensive analytical framework, this article presents a systematic review of the literature on postapartheid AIDS policy in South Africa. The analysis demonstrates that a complex interplay among the content, context, actors and process of AIDS policy created a gap between policy making and policy implementation, which rendered near-ideal AIDS policies ineffective. Secondly, we evaluate the chances of success of the current NSP by examining both the policy-making phase and the resulting policy document in light of the reasons for past policy failures. Our analysis shows that the NSP contains dynamic and comprehensive policy content, sensitive to the socio-economic and cultural dimensions of HIV/AIDS. However, many of the political actors that hampered treatment implementation in the past, and who deepened the gap between government and civil society, are still in office. Monetary and human resource shortages also create a policy context that is infertile for the implementation of a comprehensive HIV/AIDS strategy, as envisaged in the NSP. Finally, these health system restrictions have a clear negative impact on the process of policy implementation. Without the mobilization of people living with HIV/AIDS and their communities, the NSP will be ineffective in bridging the gap between policy intentions and policy

  8. High sensitivity C-reactive protein and cardfiac resynchronization therapy in patients with advanced heart failure

    Institute of Scientific and Technical Information of China (English)

    Chi CAI; Wei HUA; Li-Gang DING; Jing WANG; Ke-Ping CHEN; Xin-Wei YANG; Zhi-Min LIU; Shu ZHANG

    2014-01-01

    Background The data on the prognostic values of high sensitivity C-reactive protein (hsCRP) levels in patients with advanced symp-tomatic heart failure (HF) receiving cardiac resynchronization therapy (CRT) are scarce. The aim of present study was to investigate the association of serum hsCRP levels with left ventricle reverse remodeling after six months of CRT as well as long-term outcome. Methods A total of 232 CRT patients were included. The assessment of hsCRP values, clinical status and echocardiographic data were performed at baseline and after six months of CRT. Long-term follow-up included all-cause mortality and hospitalizations for HF. Results During the mean follow-up periods of 31.3 ± 31.5 months, elevated hsCRP (>3 mg/L) prior to CRT was associated with a significant 2.39-fold increase (P=0.006) in the risk of death or HF hospitalizations. At 6-month follow-up, patients who responded to CRT showed significant reductions or maintained low in hsCRP levels (–0.5 ± 4.1 mg/L reduction) compared with non-responders (1.7 ± 6.1 mg/L increase, P=0.018). Com-pared with patients in whom 6-month hsCRP levels were reduced or remained low, patients in whom 6-month hsCRP levels were increased or maintained high experienced a significantly higher risk of subsequent death or HF hospitalizations (Log-rank P<0.001). The echocardio-graphic improvement was also better among patients in whom 6-month hsCRP levels were reduced or remained low compared to those in whom 6-month hsCRP levels were raised or maintained high. Conclusions Our findings demonstrated that measurement of baseline and follow-up hsCRP levels may be useful as prognostic markers for timely potential risk stratification and subsequent appropriate treatment strategies in patients with advanced HF undergoing CRT.

  9. NATO Advanced Research Institute on the Application of Systems Science to Energy Policy Planning

    CERN Document Server

    Cherniavsky, E; Laughton, M; Ruff, L

    1981-01-01

    The Advanced Research Institute (ARI) on "The Application of Systems Science to Energy Policy Planning" was held under the auspices of the NATO Special Programme Panel on Systems Science in collaboration with the National Center for Analysis of Energy Sys­ tems, Brookhaven National Laboratory, USA, as a part of the NATO Science Committee's continuous effort to promote the advancement of science through international cooperation. Advanced Research Institutes are sponsored by the NATO Science Committee for the purposes of bringing together senior scientists to seek consensus on an assessment of the present state of knowl­ edge on a specific topic and to make recommendations for future research directions. Meetings are structured to encourage inten­ sive group discussion. Invitees are carefully selected so that the group as a whole will contain the experience and expertise neces­ sary to make the conclusions valid and significant. A final report is published presenting the various viewpoints and conclusions....

  10. Success, Failure, and Unfinished Business of Education, Prevention, Policy, and Intervention Programs on Substance Misuse in Brazilian Sport.

    Science.gov (United States)

    Santos, Azenildo M

    2015-01-01

    The current Brazilian situation is such that it is difficult to obtain a worldwide evaluation of failure in education, intervention, or prevention programs. How fragile Brazil's anti-doping system is, its appropriateness as well as its relevance, with needed policy infrastructures for achieving the selected goals, and how wide the gap is between education and prevention program effectiveness between high-performance athletes and recreational practitioners who just want to look good. An additional concern, and ever present flaw regarding Brazil's "common sportsman" in day-to-day society is their not receiving known and necessary "sports education," enabling the development of an "at-risk" population for self-harm. Reflections on public health policy are noted.

  11. Mathematical modeling of a multi-product EMQ model with an enhanced end items issuing policy and failures in rework.

    Science.gov (United States)

    Chiu, Yuan-Shyi Peter; Sung, Peng-Cheng; Chiu, Singa Wang; Chou, Chung-Li

    2015-01-01

    This study uses mathematical modeling to examine a multi-product economic manufacturing quantity (EMQ) model with an enhanced end items issuing policy and rework failures. We assume that a multi-product EMQ model randomly generates nonconforming items. All of the defective are reworked, but a certain portion fails and becomes scraps. When rework process ends and the entire lot of each product is quality assured, a cost reduction n + 1 end items issuing policy is used to transport finished items of each product. As a result, a closed-form optimal production cycle time is obtained. A numerical example demonstrates the practical usage of our result and confirms a significant savings in stock holding and overall production costs as compared to that of a prior work (Chiu et al. in J Sci Ind Res India, 72:435-440 2013) in the literature.

  12. Globalisation, rural restructuring and health service delivery in Australia: policy failure and the role of social work?

    Science.gov (United States)

    Alston, Margaret

    2007-05-01

    The impacts of globalisation and rural restructuring on health service delivery in rural Australia have been significant. In the present paper, it is argued that declining health service access represents a failure of policy. Rural communities across the world are in a state of flux, and Australia is no different: rural communities are ageing at faster rates than urban communities and young people are out-migrating in large numbers. During the past 5 years, rural Australia has also experienced a severe and widespread drought that has exacerbated rural poverty, and impacted on the health and well-being of rural Australians. Australian governments have responded to globalising forces by introducing neoliberal policy initiatives favouring market solutions and championing the need for self-reliance among citizens. The result for rural Australia has been a withdrawal of services at a time of increased need. This paper addresses the social work response to these changes.

  13. Recent advances in treatment of heart failure [version 1; referees: 2 approved

    OpenAIRE

    Takeshi Kitai; WH Wilson Tang

    2015-01-01

    With the total cases and economic burden of heart failure continuing to rise, there is an overwhelming need for novel therapies. Several drugs for heart failure have succeeded in preclinical and early-phase clinical trials, but most of them failed to show the real benefit in pivotal clinical trials. Meanwhile, the US Food and Drug Administration recently approved two promising new drugs to treat heart failure: ivabradine and sacubitril/valsartan. Furthermore, some of the newer agents in testi...

  14. Readiness to participate in advance care planning: A qualitative study of renal failure patients, families and healthcare providers.

    Science.gov (United States)

    Hutchison, Lauren A; Raffin-Bouchal, Donna S; Syme, Charlotte A; Biondo, Patricia D; Simon, Jessica E

    2017-01-01

    Objectives Advance care planning is the process by which people reflect upon their wishes and values for healthcare, discuss their choices with family and friends and document their wishes. Readiness represents a key predictor of advance care planning participation; however, the evidence for addressing readiness is scarce within the renal failure context. Our objectives were to assess readiness for advance care planning and barriers and facilitators to advance care planning uptake in a renal context. Methods Twenty-five participants (nine patients, nine clinicians and seven family members) were recruited from the Southern Alberta Renal Program. Semi-structured interviews were recorded, transcribed and then analyzed using interpretive description. Results Readiness for advance care planning was driven by individual values perceived by a collaborative encounter between clinicians and patients/families. If advance care planning is not valued, then patients/families and clinicians are not ready to initiate the process. Patients and clinicians are delaying conversations until "illness burden necessitates," so there is little "advance" care planning, only care planning in-the-moment closer to the end of life. Discussion The value of advance care planning in collaboration with clinicians, patients and their surrogates needs reframing as an ongoing process early in the patient's illness trajectory, distinguished from end-of-life decision making.

  15. Policy Debate | Ecuador’s Yasuní-ITT Initiative : What Can We Learn from its Failure?

    Directory of Open Access Journals (Sweden)

    Pamela L. Martin

    2014-05-01

    Full Text Available Editor’s note: This paper is a contribution to the ‘Policy Debate’ section of International Development Policy. In this section, academics, policy-makers and practioners engage in a dialogue on global development challenges. Papers are copy-edited but not peer-reviewed. Instead, the initial thematic contribution is followed by critical comments and reactions from scholars and/or policy-makers.In her article ‘Pay to Preserve: The Global Politics of Ecuador’s Yasuní-ITT Proposal’, published in DevPol’s special issue on  Energy and Development in 2011, Pamela L. Martin, Associate Professor of Politics at the Coastal Carolina University in Conway, South Carolina, provided a favourable outlook on Ecuador’s innovative environmental governance mechanism. Accordingly, its unique potential lay in its objective of contributing towards sustainable development and social justice and in case of success, the author even predicted a possible replication in other developing countries. Despite its benefits, the initiative was abandoned in 2013. In this paper, Martin revisits the initiative and analyses the reasons for its failure, namely President Correa’s public pursuit of a Plan B, entering into negotiations with oil firms interested to explore the ITT reserves. Moreover, the initiative was in stark competition with the national REDD+ programme, the mainstream policy approach to reduce emissions from deforestation and forest degradation against payments, which is being negotiated under the United Nations Framework Convention on Climate Change (UNFCCC.Pamela L. Martin’s article is followed by a response by Dr. Imme Scholz, Deputy Director of the German Development Institute/Deutsches Institut für Entwicklungspolitik (DIE. She examines why Germany, as the largest European donor, withdrew its support for the Yasuní-ITT Initiative.Readers who are intetested are invited to contribute to this policy debate on our blog .Download the whole

  16. UNDERSTANDING POLICY FAILURE IN THE EFFORT TO SITE FACILITIES FOR NUCLEAR WASTE DISPOSAL. (R823191)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  17. MYTH-MAKING, MORAL COMMUNITIES, AND POLICY FAILURE IN SOLVING THE RADIOACTIVE WASTE PROBLEM. (R823191)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  18. MYTH-MAKING, MORAL COMMUNITIES, AND POLICY FAILURE IN SOLVING THE RADIOACTIVE WASTE PROBLEM. (R823191)

    Science.gov (United States)

    The perspectives, information and conclusions conveyed in research project abstracts, progress reports, final reports, journal abstracts and journal publications convey the viewpoints of the principal investigator and may not represent the views and policies of ORD and EPA. Concl...

  19. Japanese Prime Minister Shinzo Abe's two administrations: successes and failures of domestic and security policies

    OpenAIRE

    Lee, Dae Kyu

    2016-01-01

    Approved for public release; distribution is unlimited Japanese Prime Minister Shinzo Abe's two premierships were different from one another, with his second tenure proving to be relatively successful. This study compares the two Abe administrations, focusing on agenda setting, economic policy, election tactics, and security policy. It provides relevant explanations for Abe's political success in his second administration. Abe's pragmatism in statecraft mainly originated from his own polit...

  20. New medicinal products for chronic heart failure : Advances in clinical trial design and efficacy assessment

    NARCIS (Netherlands)

    Cowie, Martin R.; Filippatos, Gerasimos S.; Garcia, Maria de los Angeles Alonso; Anker, Stefan D.; Baczynska, Anna; Bloomfield, Daniel M.; Borentain, Maria; Slot, Karsten Bruins; Cronin, Maureen; Doevendans, Pieter A.; El-Gazayerly, Amany; Gimpelewicz, Claudio; Honarpour, Narimon; Janmohamed, Salim; Janssen, Heidi; Kim, Albert M.; Lautsch, Dominik; Laws, Ian; Lefkowitz, Martin; Lopez-Sendon, Jose; Lyon, Alexander R.; Malik, Fady I.; McMurray, John J. V.; Metra, Marco; Perez, Santiago Figueroa; Pfeffer, Marc A.; Pocock, Stuart J.; Ponikowski, Piotr; Prasad, Krishna; Richard-Lordereau, Isabelle; Roessig, Lothar; Rosano, Giuseppe M. C.; Sherman, Warren; Stough, Wendy Gattis; Swedberg, Karl; Tyl, Benoit; Zannad, Faiez; Boulton, Caroline; De Graeff, Pieter

    Despite the availability of a number of different classes of therapeutic agents with proven efficacy in heart failure, the clinical course of heart failure patients is characterized by a reduction in life expectancy, a progressive decline in health-related quality of life and functional status, as

  1. Base Stock Policy in a Join-Type Production Line with Advanced Demand Information

    Science.gov (United States)

    Hiraiwa, Mikihiko; Tsubouchi, Satoshi; Nakade, Koichi

    Production control such as the base stock policy, the kanban policy and the constant work-in-process policy in a serial production line has been studied by many researchers. Production lines, however, usually have fork-type, join-type or network-type figures. In addition, in most previous studies on production control, a finished product is required at the same time as arrival of demand at the system. Demand information is, however, informed before due date in practice. In this paper a join-type (assembly) production line under base stock control with advanced demand information in discrete time is analyzed. The recursive equations for the work-in-process are derived. The heuristic algorithm for finding appropriate base stock levels of all machines at short time is proposed and the effect of advanced demand information is examined by simulation with the proposed algorithm. It is shown that the inventory cost can decreases with little backlogs by using the appropriate amount of demand information and setting appropriate base stock levels.

  2. Advancing geriatrics research, education, and practice: policy challenges after the great recession.

    Science.gov (United States)

    Zerzan, Judy T; Rich, Eugene C

    2014-06-01

    The series of articles in this JGIM issue provides a number of policy-relevant recommendations for advancing geriatrics research, education and practice. Despite the unprecedented pressure to reduce state and federal spending, policymakers must concurrently address the challenges of a growing population of older individuals with increasingly complex health care problems. Thus, there may be opportunities to advance this agenda in creative ways. For example, without new spending, federal research agencies can make changes to encourage needed new directions in aging research, and the ACA provides new funding opportunities such as the Patient Centered Outcomes Research Institute. States and the federal government have an increasing need for the health professions workforce to have collaborative care skills and geriatrics clinical competencies, and are finding ways to invest in relevant initiatives. On the clinical program side, state and federal governments are initiating programs to promote delivery system changes that improve the care of older adults. Nonetheless, in the face of the policy challenges that have persisted after the "great recession," academic geriatrics and general internal medicine will need to join forces with public and private interests to secure the resources needed to advance this ambitious agenda for geriatrics research, education and practice.

  3. Success after Failure: Academic Effects and Psychological Implications of Early Universal Algebra Policies

    Science.gov (United States)

    Howard, Keith A.; Scott, Allison; Romero, Martin; Saddler, Derrick

    2015-01-01

    In this article, the authors use the High School Longitudinal Study 2009 (HSLS:09) national database to analyze the relationships between algebra failure, subsequent performance, motivation, and college readiness. Students who failed eighth-grade Algebra I did not differ significantly in mathematics proficiency from those who passed lower-level…

  4. Panama: Military Victory, Interagency Failure: A Case Study of Policy Implementation

    Science.gov (United States)

    1993-12-17

    Crisis, 1987 to 1990, is an interesting study in foreign policy *on. To be useful, the case must be more than interesting, it must be relevant, acessible ...Claypool, Robert G. *Military Medicine as and Instrument of Power An Overview and Assessment." Study Project, U.S. Army War College, 1989. Connaughton

  5. Producer-retailer integrated EMQ system with machine breakdown, rework failures, and a discontinuous inventory issuing policy.

    Science.gov (United States)

    Chiu, Singa Wang; Chen, Shin-Wei; Chiu, Yuan-Shyi Peter; Li, Ting-Wei

    2016-01-01

    This study develops two extended economic manufacturing quantity (EMQ)-based models with a discontinuous product issuing policy, random machine breakdown, and rework failures. Various real conditions in production processes, end-product delivery, and intra-supply chains such as a producer-retailer integrated scheme are examined. The first model incorporates a discontinuous multi-delivery policy into a prior work (Chiu et al. in Proc Inst Mech Eng B J Eng 223:183-194, 2009) in lieu of their continuous policy. Such an enhanced model can address situations in supply chain environments, where finished products are transported to outside retail stores (or customers). The second model further combines retailer's stock holding costs into the first model. This extended EMQ model is applicable in situations in present-day manufacturing firms where finished products are distributed to company's own retail stores (or regional sales offices) and stocked there for sale. Two aforementioned extended EMQ models are investigated, respectively. Mathematical modeling along with iterative algorithms are employed to derive the optimal production run times that minimize the expected total system costs, including the costs incurred in production units, transportation, and retail stores, for these integrated EMQ systems. Numerical examples are provided to demonstrate the practical application of the research results.

  6. Orange Juice or Orange Drink? Ensuring that "Advanced Courses" Live up to Their Labels. NCEA Policy Brief No. 1

    Science.gov (United States)

    Dougherty, Chrys; Mellor, Lynn; Jian, Shuling

    2006-01-01

    The pressure to improve high school students' academic results has led many schools and districts to take the first step of enrolling more students in advanced courses. Business and state policy leaders have encouraged this practice. However, the hard part of the bargain is to ensure that students actually learn the advanced content implied by the…

  7. Recent advances in treatment of heart failure [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Takeshi Kitai

    2015-12-01

    Full Text Available With the total cases and economic burden of heart failure continuing to rise, there is an overwhelming need for novel therapies. Several drugs for heart failure have succeeded in preclinical and early-phase clinical trials, but most of them failed to show the real benefit in pivotal clinical trials. Meanwhile, the US Food and Drug Administration recently approved two promising new drugs to treat heart failure: ivabradine and sacubitril/valsartan. Furthermore, some of the newer agents in testing offer the potential for significant progress in addition to these drugs. Patiromer and zirconium cyclosilicate are attractive agents that are expected to prevent hyperkalemia during renin-angiotensin-aldosterone system inhibition, and serelaxin and urodilatin are promising drugs in the treatment of acute heart failure. Future clinical trials with more appropriate study designs, optimal clinical endpoints, and proper patient selection are mandatory to assess the true efficacy of these attractive compounds in clinical practice.

  8. [Serum albumin and heart failure: recent advances on a new paradigm].

    Science.gov (United States)

    Arques, S

    2011-11-01

    Hypoalbuminemia is a common condition in patients with heart failure and is mainly related to the malnutrition-inflammation complex syndrome. Other causal factors can be involved, which include hemodilution, liver dysfunction, increased transcapillary escape rate, renal and enteral loss. Evidence is growing that hypoalbuminemia independently predicts incident heart failure in patients with end-stage renal disease and elderly patients, as well as mortality in patients with heart failure regardless of left ventricular ejection fraction and clinical presentation. Hypoalbuminemia induces a low plasma oncotic pressure, which facilitates pulmonary edema in patients without critical increase in pulmonary capillary hydrostatic pressures. Hypoalbuminemia may also contribute to the progression of heart failure by favoring myocardial edema, volume overload, diuretic resistance and exacerbation of oxidative stress and inflammation. If relevant, removal of subclinical excess of fluid and renutrition may be indicated in patients with heart failure and hypoalbuminemia. Additional research is warranted to determine the specific role of serum albumin in the pathophysiologic process of heart failure and the potential benefits of targeted therapeutic interventions.

  9. Effects of Fusion Zone Size on Failure Modes and Performance of Advanced High Strength Steel Spot Welds

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Xin; Stephens, Elizabeth V.; Khaleel, Mohammad A.

    2006-04-28

    This paper examines the effects of fusion zone size on failure modes, static strength and energy absorption of resistance spot welds (RSW) of advanced high strength steels (AHSS). DP800 and TRIP800 spot welds are considered. The main failure modes for spot welds are nugget pullout and interfacial fracture. Partial interfacial fracture is also observed. The critical fusion zone sizes to ensure nugget pull-out failure mode are developed for both DP800 and TRIP800 using the limit load based analytical model and the micro-hardness measurements of the weld cross sections. Static weld strength tests using cross tension samples were performed on the joint populations with controlled fusion zone sizes. The resulted peak load and energy absorption levels associated with each failure mode were studied using statistical data analysis tools. The results in this study show that the conventional weld size of 4 t can not produce nugget pullout mode for both the DP800 and TRIP800 materials. The results also suggest that performance based spot weld acceptance criteria should be developed for different AHSS spot welds.

  10. Advances on the Failure Analysis of the Dam—Foundation Interface of Concrete Dams

    Directory of Open Access Journals (Sweden)

    Luis Altarejos-García

    2015-12-01

    Full Text Available Failure analysis of the dam-foundation interface in concrete dams is characterized by complexity, uncertainties on models and parameters, and a strong non-linear softening behavior. In practice, these uncertainties are dealt with a well-structured mixture of experience, best practices and prudent, conservative design approaches based on the safety factor concept. Yet, a sound, deep knowledge of some aspects of this failure mode remain unveiled, as they have been offset in practical applications by the use of this conservative approach. In this paper we show a strategy to analyse this failure mode under a reliability-based approach. The proposed methodology of analysis integrates epistemic uncertainty on spatial variability of strength parameters and data from dam monitoring. The purpose is to produce meaningful and useful information regarding the probability of occurrence of this failure mode that can be incorporated in risk-informed dam safety reviews. In addition, relationships between probability of failure and factors of safety are obtained. This research is supported by a more than a decade of intensive professional practice on real world cases and its final purpose is to bring some clarity, guidance and to contribute to the improvement of current knowledge and best practices on such an important dam safety concern.

  11. New medicinal products for chronic heart failure: advances in clinical trial design and efficacy assessment.

    Science.gov (United States)

    Cowie, Martin R; Filippatos, Gerasimos S; Alonso Garcia, Maria de Los Angeles; Anker, Stefan D; Baczynska, Anna; Bloomfield, Daniel M; Borentain, Maria; Bruins Slot, Karsten; Cronin, Maureen; Doevendans, Pieter A; El-Gazayerly, Amany; Gimpelewicz, Claudio; Honarpour, Narimon; Janmohamed, Salim; Janssen, Heidi; Kim, Albert M; Lautsch, Dominik; Laws, Ian; Lefkowitz, Martin; Lopez-Sendon, Jose; Lyon, Alexander R; Malik, Fady I; McMurray, John J V; Metra, Marco; Figueroa Perez, Santiago; Pfeffer, Marc A; Pocock, Stuart J; Ponikowski, Piotr; Prasad, Krishna; Richard-Lordereau, Isabelle; Roessig, Lothar; Rosano, Giuseppe M C; Sherman, Warren; Stough, Wendy Gattis; Swedberg, Karl; Tyl, Benoit; Zannad, Faiez; Boulton, Caroline; De Graeff, Pieter

    2017-06-01

    Despite the availability of a number of different classes of therapeutic agents with proven efficacy in heart failure, the clinical course of heart failure patients is characterized by a reduction in life expectancy, a progressive decline in health-related quality of life and functional status, as well as a high risk of hospitalization. New approaches are needed to address the unmet medical needs of this patient population. The European Medicines Agency (EMA) is undertaking a revision of its Guideline on Clinical Investigation of Medicinal Products for the Treatment of Chronic Heart Failure. The draft version of the Guideline was released for public consultation in January 2016. The Cardiovascular Round Table of the European Society of Cardiology (ESC), in partnership with the Heart Failure Association of the ESC, convened a dedicated two-day workshop to discuss three main topic areas of major interest in the field and addressed in this draft EMA guideline: (i) assessment of efficacy (i.e. endpoint selection and statistical analysis); (ii) clinical trial design (i.e. issues pertaining to patient population, optimal medical therapy, run-in period); and (iii) research approaches for testing novel therapeutic principles (i.e. cell therapy). This paper summarizes the key outputs from the workshop, reviews areas of expert consensus, and identifies gaps that require further research or discussion. Collaboration between regulators, industry, clinical trialists, cardiologists, health technology assessment bodies, payers, and patient organizations is critical to address the ongoing challenge of heart failure and to ensure the development and market access of new therapeutics in a scientifically robust, practical and safe way. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  12. Hybrid Modeling for Scenario-Based Evaluation of Failure Effects in Advanced Hardware-Software Designs

    Science.gov (United States)

    Malin, Jane T.; Fleming, Land; Throop, David

    2001-01-01

    This paper describes an incremental scenario-based simulation approach to evaluation of intelligent software for control and management of hardware systems. A hybrid continuous/discrete event simulation of the hardware dynamically interacts with the intelligent software in operations scenarios. Embedded anomalous conditions and failures in simulated hardware can lead to emergent software behavior and identification of missing or faulty software or hardware requirements. An approach is described for extending simulation-based automated incremental failure modes and effects analysis, to support concurrent evaluation of intelligent software and the hardware controlled by the software

  13. Incorporation of a community pharmacy-based heart failure assessment tool by advanced pharmacy practice experience students.

    Science.gov (United States)

    Kelling, Sarah E; Walker, Paul C; Mason, James G; Zara, Nadir; Bleske, Barry E

    To incorporate a published clinical tool related to heart failure (HF) assessment into advanced pharmacy practice experiences in the community pharmacy setting to provide a meaningful and innovative learning experience for students. Sixteen independent and chain community pharmacies that served as advanced pharmacy practice experience locations. Sixteen community pharmacy locations served as rotation sites and participated in data collection (8 chain and 8 independent). This was the first study in which pharmacy students used The One-Minute Clinic for Heart Failure (TOM-C HF) tool to assess HF within the community pharmacy setting. Trained student pharmacists identified patients who may have heart failure by evaluating medication dispensing records, interviewed the patient using the TOM-C HF tool, and made interventions as clinically appropriate. The number of students using the TOM-C HF tool, the number and types of interventions made, and student perceptions about the educational and professional value of the patient interaction. Thirty-three of 83 (40%) students completed 63 patient assessments. Thirty-five percent of patients (22/63) were candidates for an intervention. Interventions were performed in 9 of 22 patients (41%). More than 65% of students found the patient interaction to have educational and professional value. Students were able to assess HF patients and make interventions in a community pharmacy setting. The majority of students also perceived some value in these assessments. The incorporation of a clinical tool in the community setting driven by fourth-year pharmacy students has been shown to be feasible and to provide both a novel advanced practice experience. In addition, it may be expandable to the services offered at community pharmacies. Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  14. Chronic beta-blocker treatment in patients with advanced heart failure - Effects on neurohormones

    NARCIS (Netherlands)

    Teisman, ACH; van Veldhuisen, DJ; Boomsma, F; de Kam, PJ; Pinto, YM; de Zeeuw, D; van Gilst, WH

    2000-01-01

    Background: To date, the use of beta-blockers in treating patients with chronic heart failure gains support, this since several large clinical trials reported reduced mortality after chronic beta-blockade. Part of these beneficial effects may result from inhibition of deleterious neurohormone activa

  15. Explaining Policy Responses to Danish and Irish Banking Failures during the Financial Crisis

    DEFF Research Database (Denmark)

    Kluth, Michael Friederich; Lynggaard, Kennet

    2013-01-01

    The 2008 global financial crisis produced very different responses in Ireland and Denmark. While both countries embraced depositor guarantee schemes and recapitalization programmes, these were designed and adopted in significantly different ways. Crucially, the Irish state initially assumed full...... responsibility for sector losses and only later defined terms for industry contributions. In Denmark, a negotiated settlement from the outset transferred most of the risk associated with banking failures collectively to the banking sector. The article assesses two explanations for these different responses: 1......) variations in domestic exposure to the financial industry, notably its relative size, dominant business models and exposure to real estate markets and 2) variations in institutional features, notably banking sector preferences and legacies of collective action. While limited explanatory power can...

  16. Reversible Motor Paralysis and Early Cardiac Rehabilitation in Patients With Advanced Heart Failure Receiving Left Ventricular Assist Device Therapy.

    Science.gov (United States)

    Amao, Rie; Imamura, Teruhiko; Nakahara, Yasuo; Noguchi, Satoko; Kinoshita, Osamu; Yamauchi, Haruo; Ono, Minoru; Haga, Nobuhiko

    2016-12-02

    Advanced heart failure (HF) is sometimes complicated with brain impairment because of a microthrombosis caused by decreased left ventricular contraction or reduced brain circulation. Some patients may recover after left ventricular assist device (LVAD) implantation. However, little is known about the perioperative therapeutic strategy in patients suffering from such complications, particularly from a cardiac rehabilitation viewpoint. We report on a 58-year-old male patient with a previous history of poliomyelitis and a light paralysis in the left upper extremity, who suffered left hemiplegia with no evidence of stroke after hemodynamic deterioration. The combination therapy of perioperative cardiac rehabilitation and LVAD therapy improved his left hemiplegia as well as activities of daily living, and the patient was discharged on foot on postoperative day 72 after briefing the family on LVAD home management. Early initiation of cardiac rehabilitation before LVAD implantation may be a key for the smooth discharge and resocialization of patients suffering from brain impairment complicated with advanced HF.

  17. Relationship between advanced glycation end-products with the severity of chronic heart failure in 85 patients

    Directory of Open Access Journals (Sweden)

    Amir Farhang Zand Parsa

    2013-12-01

    Full Text Available Background: Advanced glycation end-products (AGEs came up with the recent researches regarding new biomarkers for the diagnosis of heart failure. AGEs are the end products of non-enzymatic glycation and oxidation of proteins, lipids and nucleotides during Maillard biochemical reaction. Although it has been known that AGEs have a role in the pathogenesis of chronic heart failure (CHF, information regarding its role and its pathogenetic mechanism is very limited. The aim of this study was to find any relationship between AGEs with the etiology and severity of chronic heart failure.Methods: This study is a prospective cross sectional study that enrolled 85 patients with chronic heart failure. Measurement of left ventricle ejection fraction (LVEF was done by echocardiography. Blood samples were collected for measuring AGEs just before or after echocardiography assessment (in the same session. Measurement of AGEs was done by the enzyme-linked immunosorbent assay (ELISA method. The relationship between AGEs with the severity of CHF and as well as the etiology of CHF were evaluated via SPSS-15.Results: Of 85 patients 48 (56.5% patients were male and 37 (43.5% were female; Mean±SD of their ages was 55.8±13.4 years old (ranges from 27 to 84 years. Correlation coefficient between LVEF and AGEs was 0.269 (P=0.013. Mean of AGEs in patients with and without ischemic etiology of their heart failure were 16.8±9.8µg/ml and 11.6±7.3 µg/ml, respectively. Although trend was in favor of ischemic heart failure, the difference between two groups was not statistically significant (P= 0.141.Conclusion: According to this study the rate of AGES could be helpful in the diagnosis and assessment of severity of CHF. Based on our findings, higher blood levels of AGEs in the ischemic CHF cases, also it could be concluded that in the future this marker may be used for etiologic differentiation of heart failure syndrome.

  18. Meteorological Satellites (METSAT) and Earth Observing System (EOS) Advanced Microwave Sounding Unit-A (AMSU-A) Failure Modes and Effects Analysis (FMEA) and Critical Items List (CIL)

    Science.gov (United States)

    1996-01-01

    This Failure Modes and Effects Analysis (FMEA) is for the Advanced Microwave Sounding Unit-A (AMSU-A) instruments that are being designed and manufactured for the Meteorological Satellites Project (METSAT) and the Earth Observing System (EOS) integrated programs. The FMEA analyzes the design of the METSAT and EOS instruments as they currently exist. This FMEA is intended to identify METSAT and EOS failure modes and their effect on spacecraft-instrument and instrument-component interfaces. The prime objective of this FMEA is to identify potential catastrophic and critical failures so that susceptibility to the failures and their effects can be eliminated from the METSAT/EOS instruments.

  19. Basic failure mechanisms in advanced composites. [composed of epoxy resins reinforced with carbon fibers

    Science.gov (United States)

    Mazzio, V. F.; Mehan, R. L.; Mullin, J. V.

    1973-01-01

    The fundamental failure mechanisms which result from the interaction of thermal cycling and mechanical loading of carbon-epoxy composites were studied. This work was confined to epoxy resin uniderictionally reinforced with HTS carbon fibers, and consists of first identifying local fiber, matrix and interface failure mechanisms using the model composite specimen containing a small number of fibers so that optical techniques can be used for characterization. After the local fracture process has been established for both mechanical loading and thermal cycling, engineering composite properties and gross fracture modes are then examined to determine how the local events contribute to real composite performance. Flexural strength in high fiber content specimens shows an increase in strength with increased thermal cycling. Similar behavior is noted for 25 v/o material up to 200 cycles; however, there is a drastic reduction after 200 cycles indicating a major loss of integrity probably through the accumulation of local cleavage cracks in the tensile region.

  20. Patient views of social service provision for older people with advanced heart failure.

    Science.gov (United States)

    Gott, Merryn; Barnes, Sarah; Payne, Sheila; Parker, Chris; Seamark, David; Gariballa, Salah; Small, Neil

    2007-07-01

    The objective of the present paper is to explore levels of social service provision, the barriers to receiving these services and the experiences of social service provision amongst older people with heart failure. Five hundred and forty-two people aged over 60 years with heart failure were recruited from UK general practices in four areas of the UK, and these subjects completed quality-of-life and service-use questionnaires every 3 months for 24 months, or until death. Forty patients participated in in-depth interviews. Data collection was conducted between September 2003 and March 2006. Only 24% (n = 127) of the 460 participants who had provided information about social services contact reported having received social services during the past 24 months. Significant associations between the level of social services contact and participant characteristics were identified, with women, participants over 75 years of age, participants living alone, and those with two or more comorbidities being more likely to report receipt of social services. The qualitative data identified key barriers to using social services, including: access problems; not wanting additional help; the negative experiences of friends; and carers substituting for statutory services. The few participants interviewed who had received social services reported mixed experiences, including problems with inappropriate and insufficient services. This study indicates that only a minority of older people with heart failure have contact with social services. Improving provision for this group involves tackling the barriers to access identified above, as well as ensuring that their views influence service planning and delivery.

  1. Chronic lower limb ischemia and advanced renal failure. Do we possess sufficient therapeutic knowledge?

    Science.gov (United States)

    Gacka, M; Adamiec, R

    2013-08-01

    Chronic lower limb ischemia diminishes the quality of life and is associated with a higher risk of limb amputation and cardiovascular mortality. Coexisting chronic renal disease can modulate the response to pharmacotherapy and revascularization, and thus influence prognosis. This paper reviews current literary evidence regarding therapeutic problems observed in patients with obliterative atherosclerosis and renal failure. We reviewed articles from peer-reviewed medical journals which were published between 2000 and 2011. The poorer clinical response in the discussed patients is not only connected with the direct failure of surgical and endovascular procedures, but first of all with the high mortality of the patients. There is still a lack of sufficient evidence on the effectiveness of currently used anti-atherosclerotic agents in patients with end-stage renal failure. A certain priority is the search for an effective therapeutic strategy that would reduce mortality associated with cardiovascular conditions in this particular group of patients. Identifying patients who can benefit most from costly endovascular procedures is another vital issue.

  2. Protection of Urban Lands: Advances in Medellin’s Public Policy

    Directory of Open Access Journals (Sweden)

    Clara Inés Atehortúa-Arredondo

    2010-11-01

    Full Text Available The problem of land ownership protection in this country is an issue that must be faced by those who have as part of their responsibilities the recognition, the restitution and the reparation of victims of forced displacement. One of the points that must be analyzed is the protection of ownership of urban lands, a subject falling under municipal responsibility. The development of a public policy by the City of Medellín for the protection of such lands is a significant advance for the creation of protocols and for the return of rights to those who have adandoned their lands because of violence or who have been divested of their homes in urban areas.

  3. Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management.

    Science.gov (United States)

    Mulshine, James L; Avila, Rick; Yankelevitz, David; Baer, Thomas M; Estépar, Raul San Jose; Ambrose, Laurie Fenton; Aldigé, Carolyn R

    2015-05-01

    The Prevent Cancer Foundation Lung Cancer Workshop XI: Tobacco-Induced Disease: Advances in Policy, Early Detection and Management was held in New York, NY on May 16 and 17, 2014. The two goals of the Workshop were to define strategies to drive innovation in precompetitive quantitative research on the use of imaging to assess new therapies for management of early lung cancer and to discuss a process to implement a national program to provide high quality computed tomography imaging for lung cancer and other tobacco-induced disease. With the central importance of computed tomography imaging for both early detection and volumetric lung cancer assessment, strategic issues around the development of imaging and ensuring its quality are critical to ensure continued progress against this most lethal cancer.

  4. The Down Syndrome Information Act: Balancing the Advances of Prenatal Testing Through Public Policy.

    Science.gov (United States)

    Leach, Mark W

    2016-04-01

    Since the dawn of prenatal testing in the 1970s, concerns have been raised over its administration to respect a mother's autonomy as well as the expressive critique against those with the tested-for condition. Advances in prenatal testing have made it such that more mothers than ever are given a test result of Down syndrome, yet are not provided the rest of the information recommended by professional guidelines. In response, first federal legislation and then, increasingly, state legislation is requiring that this information be provided to expectant mothers. Though receiving broad bipartisan support in passage, some of the statutes have received criticism. These public policy measures will be surveyed and evaluated as to their relative merits and limitations.

  5. Long-term outcome of patients with multiple [corrected] myeloma-related advanced renal failure following auto-SCT.

    Science.gov (United States)

    Glavey, S V; Gertz, M A; Dispenzieri, A; Kumar, S; Buadi, F; Lacy, M; Hayman, S R; Kapoor, P; Dingli, D; McCurdy, A; Hogan, W J; Gastineau, D A; Leung, N

    2013-11-01

    Renal failure commonly complicates multiple myeloma (MM) and is associated with reduced survival. It is not clear whether auto-SCT results in improved renal function or attainment of independence from dialysis in patients with advanced renal impairment due to MM. We conducted a retrospective cohort study of all patients who underwent auto-SCT for MM complicated by advanced renal failure at our institution over a 10-year period (2000-2010). We aimed to assess the association between auto-SCT and renal outcome in patients with serum creatinine (SCr) over 3 mg/dL, attributable to MM, including those who were dialysis dependent. Thirty patients (2.8% of all auto-SCT patients) met inclusion criteria. Fourteen of 15 patients who were dialysis dependent before auto-SCT remained dialysis dependent in the long term despite hematological response (HR). Of the remaining 15 patients with SCr >3 mg/dL, an improvement in glomerular filtration rate (GFR) from 15 to 19.4 mL/min/1.73 m(2) was noted post auto-SCT (P=0.035); however, neither HR post auto-SCT or pre-existing renal function were independently associated with renal outcome. Auto-SCT was not associated with independence from dialysis in patients with renal failure due to MM at our institution. Although auto-SCT was associated with an improvement in GFR in patients with SCr >3 mg/dL, this improvement was not related to HR.

  6. An advanced pharmacy practice experience in application of evidence-based policy.

    Science.gov (United States)

    Neill, Kathryn K; Johnson, Jill T

    2012-09-10

    To determine the impact of an advanced pharmacy practice experience (APPE) to develop skills needed to apply an evidence-based approach to population-level practice decisions. A 4-week evidence-based medicine APPE was implemented that included active-learning techniques and online learning modules, participation in state drug-policy committee meetings, and completion of an evidence-based medicine review for a specific drug agent or class. Students' mean score on application of principles related to biostatistics and information mastery on posttests increased 15.8% from pretest to posttest. Students' mean score on a 22-question information mastery quiz was 90.8%. Mean scores for course evaluation components ranged from 4.8 to 5.0 on a 5-point Likert scale. All respondents indicated they would recommend the APPE to other students. An APPE that incorporated content from active drug-policy committees increased students' evidence-based medicine skills and enhanced their understanding of, appreciation for, and confidence in evidence-based practice.

  7. Advanced light source vacuum policy and vacuum guidelines for beamlines and experiment endstations

    Energy Technology Data Exchange (ETDEWEB)

    Hussain, Z.

    1995-08-01

    The purpose of this document is to: (1) Explain the ALS vacuum policy and specifications for beamlines and experiment endstations. (2) Provide guidelines related to ALS vacuum policy to assist in designing beamlines which are in accordance with ALS vacuum policy. This document supersedes LSBL-116. The Advanced Light Source is a third generation synchrotron radiation source whose beam lifetime depends on the quality of the vacuum in the storage ring and the connecting beamlines. The storage ring and most of the beamlines share a common vacuum and are operated under ultra-high-vacuum (UHV) conditions. All endstations and beamline equipment must be operated so as to avoid contamination of beamline components, and must include proper safeguards to protect the storage ring vacuum from an accidental break in the beamline or endstation vacuum systems. The primary gas load during operation is due to thermal desorption and electron/photon induced desorption of contaminants from the interior of the vacuum vessel and its components. The desorption rates are considerably higher for hydrocarbon contamination, thus considerable emphasis is placed on eliminating these sources of contaminants. All vacuum components in a beamline and endstation must meet the ALS vacuum specifications. The vacuum design of both beamlines and endstations must be approved by the ALS Beamline Review Committee (BRC) before vacuum connections to the storage ring are made. The vacuum design is first checked during the Beamline Design Review (BDR) held before construction of the beamline equipment begins. Any deviation from the ALS vacuum specifications must be approved by the BRC prior to installation of the equipment on the ALS floor. Any modification that is incorporated into a vacuum assembly without the written approval of the BRC is done at the user`s risk and may lead to rejection of the whole assembly.

  8. Advanced light source vacuum policy and vacuum guidelines for beamlines and experiment endstations

    Energy Technology Data Exchange (ETDEWEB)

    Hussain, Z.

    1995-08-01

    The purpose of this document is to: (1) Explain the ALS vacuum policy and specifications for beamlines and experiment endstations. (2) Provide guidelines related to ALS vacuum policy to assist in designing beamlines which are in accordance with ALS vacuum policy. This document supersedes LSBL-116. The Advanced Light Source is a third generation synchrotron radiation source whose beam lifetime depends on the quality of the vacuum in the storage ring and the connecting beamlines. The storage ring and most of the beamlines share a common vacuum and are operated under ultra-high-vacuum (UHV) conditions. All endstations and beamline equipment must be operated so as to avoid contamination of beamline components, and must include proper safeguards to protect the storage ring vacuum from an accidental break in the beamline or endstation vacuum systems. The primary gas load during operation is due to thermal desorption and electron/photon induced desorption of contaminants from the interior of the vacuum vessel and its components. The desorption rates are considerably higher for hydrocarbon contamination, thus considerable emphasis is placed on eliminating these sources of contaminants. All vacuum components in a beamline and endstation must meet the ALS vacuum specifications. The vacuum design of both beamlines and endstations must be approved by the ALS Beamline Review Committee (BRC) before vacuum connections to the storage ring are made. The vacuum design is first checked during the Beamline Design Review (BDR) held before construction of the beamline equipment begins. Any deviation from the ALS vacuum specifications must be approved by the BRC prior to installation of the equipment on the ALS floor. Any modification that is incorporated into a vacuum assembly without the written approval of the BRC is done at the user`s risk and may lead to rejection of the whole assembly.

  9. Market vs. policy failures. How governments affect electricity markets and what they should do

    Energy Technology Data Exchange (ETDEWEB)

    Jus, Darko

    2013-11-06

    This dissertation analyzes four key aspects related to the development of renewable energy. Firstly, in the presence of a climate change externality, a first-best allocation on the electricity market generally cannot be achieved with a renewable energy subsidy, thus highlighting its imperfectness in replacing a correct pricing of carbon dioxide emissions (Chapter 2). Secondly, supposing the existence of an emission trading system, this dissertation investigates the effects of additionally supporting renewable energy. Surprisingly, when considering a one-country model, the market participant who loses rents due to the introduction of a levy-financing subsidy scheme, such as the case of Germany, proves to be the fossil electricity producers rather than the electricity consumers (Chapter 3). Thirdly, considering a more realistic two-country framework, it becomes more likely that domestic electricity consumers have to accept a higher electricity price, while rents are shifted to foreign electricity consumers as a consequence of unilateral renewable energy support (Chapter 4). Fourthly, this dissertation studies reasons for employing technology-specific feed-in tariffs, and in contrast to usual intuition, finds them to be (static) efficiency improving when policy has committed to achieving a strong renewable energy target (Chapter 5).

  10. Illegal drugs, anti-drug policy failure, and the need for institutional reforms in Colombia.

    Science.gov (United States)

    Thoumi, Francisco E

    2012-01-01

    This paper is inspired by two anomalies encountered in the study of the illegal drugs industry. First, despite the very high profits of coca/cocaine and poppy/opium/heroin production, most countries that can produce do not. Why, for example, does Colombia face much greater competition in the international coffee, banana, and other legal product markets than in cocaine? And second, though illegal drugs are clearly associated with violence, why is it that illegal drug trafficking organizations have been so much more violent in Colombia and Mexico than in the rest of the world? The answers to these questions cannot be found in factors external to Colombia (and Mexico). They require identifying the societal weaknesses of each country. To do so, the history of the illegal drugs industry is surveyed, a simple model of human behavior that stresses the conflict between formal (legal) and informal (socially accepted) norms as a source of the weaknesses that make societies vulnerable is formulated. The reasons why there is a wide gap between formal and informal norms in Colombia are explored and the effectiveness of anti-drug policies is considered to explain why they fail to achieve their posited goals. The essay ends with reflections and conclusion on the need for institutional change.

  11. [Market and public policy network failures: challenges and possibilities for the Brazilian Unified Health System].

    Science.gov (United States)

    Pinheiro Filho, Francisco Percival; Sarti, Flávia Mori

    2012-11-01

    The principles and guidelines of the Brazilian Unified Health System (SUS) impose a healthcare service structure based on public policy networks which, combined with the financing model adopted, leads to market failings. This imposes barriers to the management of the public health system and the enactment of SUS objectives. The institutional characteristics and the heterogeneity of players, allied to the existence of different healthcare approaches, generate analytical complexity in the study of the global dynamics of the SUS network. There are limitations in the use of quantitative methods based on static analysis of retrospective SUS data. Thus, an approach taking SUS as a complex system using innovative quantitative methodology based on computational simulation is proposed. This paper sought to analyze challenges and possibilities of the combined application of cellular automata modeling and agent-based modeling for simulation of the evolution of the SUS healthcare service network. This approach should permit better understanding of the organization, heterogeneity and structural dynamics of the SUS service network and a minimization of the effects of market failings on the Brazilian health system.

  12. Evidence for Intramyocardial Disruption of Lipid Metabolism and Increased Myocardial Ketone Utilization in Advanced Human Heart Failure.

    Science.gov (United States)

    Bedi, Kenneth C; Snyder, Nathaniel W; Brandimarto, Jeffrey; Aziz, Moez; Mesaros, Clementina; Worth, Andrew J; Wang, Linda L; Javaheri, Ali; Blair, Ian A; Margulies, Kenneth B; Rame, J Eduardo

    2016-02-23

    The failing human heart is characterized by metabolic abnormalities, but these defects remains incompletely understood. In animal models of heart failure there is a switch from a predominance of fatty acid utilization to the more oxygen-sparing carbohydrate metabolism. Recent studies have reported decreases in myocardial lipid content, but the inclusion of diabetic and nondiabetic patients obscures the distinction of adaptations to metabolic derangements from adaptations to heart failure per se. We performed both unbiased and targeted myocardial lipid surveys using liquid chromatography-mass spectroscopy in nondiabetic, lean, predominantly nonischemic, advanced heart failure patients at the time of heart transplantation or left ventricular assist device implantation. We identified significantly decreased concentrations of the majority of myocardial lipid intermediates, including long-chain acylcarnitines, the primary subset of energetic lipid substrate for mitochondrial fatty acid oxidation. We report for the first time significantly reduced levels of intermediate and anaplerotic acyl-coenzyme A (CoA) species incorporated into the Krebs cycle, whereas the myocardial concentration of acetyl-CoA was significantly increased in end-stage heart failure. In contrast, we observed an increased abundance of ketogenic β-hydroxybutyryl-CoA, in association with increased myocardial utilization of β-hydroxybutyrate. We observed a significant increase in the expression of the gene encoding succinyl-CoA:3-oxoacid-CoA transferase, the rate-limiting enzyme for myocardial oxidation of β-hydroxybutyrate and acetoacetate. These findings indicate increased ketone utilization in the severely failing human heart independent of diabetes mellitus, and they support the role of ketone bodies as an alternative fuel and myocardial ketone oxidation as a key metabolic adaptation in the failing human heart. © 2016 American Heart Association, Inc.

  13. Soluble Isoform of the Receptor for Advanced Glycation End Products as a Biomarker for Postoperative Respiratory Failure after Cardiac Surgery

    Science.gov (United States)

    Uchida, Tokujiro; Ohno, Nagara; Asahara, Miho; Yamada, Yoshitsugu; Yamaguchi, Osamu; Tomita, Makoto; Makita, Koshi

    2013-01-01

    Purpose Postoperative respiratory failure is a major problem which can prolong the stay in the intensive care unit in patients undergoing cardiac surgery. We measured the serum levels of the soluble isoform of the receptor for advanced glycation end products (sRAGE), and we studied its association with postoperative respiratory failure. Methods Eighty-seven patients undergoing elective cardiac surgery were enrolled in this multicenter observational study in three university hospitals. Serum biomarker levels were measured perioperatively, and clinical data were collected for 7 days postoperatively. The duration of mechanical ventilation was studied for 28 days. Results Serum levels of sRAGE elevated immediately after surgery (median, 1751 pg/mL; interquartile range (IQR) 1080–3034 pg/mL) compared with the level after anesthetic induction (median, 884 pg/mL; IQR, 568–1462 pg/mL). Postoperative sRAGE levels in patients undergoing off-pump coronary artery bypass grafting (median, 1193 pg/mL; IQR 737–1869 pg/mL) were significantly lower than in patients undergoing aortic surgery (median, 1883 pg/mL; IQR, 1406–4456 pg/mL; p = 0.0024) and valve surgery (median, 2302 pg/mL; IQR, 1447–3585 pg/mL; p = 0.0005), and postoperative sRAGE correlated moderately with duration of cardiopulmonary bypass (rs = 0.44, ppostoperative sRAGE had a predictive performance with area under the curve of 0.81 (95% confidence interval 0.71–0.88) for postoperative respiratory failure, defined as prolonged mechanical ventilation >3 days. The optimum cutoff value for prediction of respiratory failure was 3656 pg/mL, with sensitivity and specificity of 62% and 91%, respectively. Conclusions Serum sRAGE levels elevated immediately after cardiac surgery, and the range of elevation was associated with the morbidity of postoperative respiratory failure. Early postoperative sRAGE levels appear to be linked to cardiopulmonary bypass, and may have predictive performance for

  14. Modelling multi-MNO business for MVNOs in their evolution to LTE, VoLTE & advanced policy

    OpenAIRE

    COPELAND, Rebecca; Crespi, Noel

    2011-01-01

    International audience; The MVNO (Mobile Virtual Network Operator) business in Europe is maturing, with growing pressure on margins. To cope, MVNOs seek independence and flexibility which they can gain by advanced 4G access agnostic technology. This evolution is supported by three overlapping MVNO models: 4G "Full MVNO", Multi-MNO and "Always Best Connected", which are all enhanced by advanced Policy functions. The paper assesses these models against top ten MVNO success factors and argues th...

  15. Developing of a software for determining advanced brake failures in brakes test bench

    Directory of Open Access Journals (Sweden)

    Hakan Köylü

    2016-08-01

    Full Text Available At present time, the brake test bench conducts the braking and suspension tests of front or rear axles and the test results are evaluated through one axle. The purpose of the brake testing system is to determine braking force and damping coefficient dissymmetry of one axle. Thus, this test system evaluates the performance of service brake, hand brake and suspension systems by considering separately front and rear axle dissymmetry. For this reason, the effects of different braking and damping forces applied by right and left wheels of both axles on braking performance of all vehicle are not determined due to available algorithm of the test bench. Also, the other brake failures are not occurred due to the algorithm of brake test system. In this study, the interface has been developed to determine the other effects of dissymmetry and the other brake failures by using the one axle results of brake test bench. The interface has algorithm computing the parameters according to the interaction between front and rear axles by only using measured test results. Also, it gives the warnings by comparing changes in the parameters with braking performance rules. Braking and suspension tests of three different vehicles have been conducted by using brake test bench to determine the performance of the algorithm. Parameters based on the axle interaction have been calculated by transferring brake test results to the interface and the test results have been evaluated. As a result, the effects of brake and suspension failures on braking performance of both axle and vehicle have been determined thanks to the developed interface.

  16. Clinical Characteristics and Outcomes of Intravenous Inotropic Therapy in Advanced Heart Failure.

    Science.gov (United States)

    Hashim, Taimoor; Sanam, Kumar; Revilla-Martinez, Marina; Morgan, Charity J; Tallaj, Jose A; Pamboukian, Salpy V; Loyaga-Rendon, Renzo Y; George, James F; Acharya, Deepak

    2015-09-01

    Inotrope use in heart failure treatment was associated with improved symptoms, but worse survival in clinical trials. However, these studies predated use of modern heart failure therapies. This study evaluates contemporary outcomes on long-term inotropes. We collected baseline and postinotrope data on 197 patients discharged on inotropes between January 2007 and March 2013. Baseline characteristics, hemodynamic and clinical changes on inotropes, and survival were evaluated. Patients initiated on inotropes had refractory heart failure, with median baseline New York Heart Association class IV, cardiac index of 1.7 L/min per m(2), pulmonary capillary wedge pressure of 25.6 mm Hg, and left ventricular ejection fraction of 18.7%. Inotropes were used in patients listed for transplant or scheduled for left ventricular assist device (LVAD; 60 patients), in patients being evaluated for LVAD/transplant (20 patients), for stabilization pending cardiac resynchronization therapy/percutaneous coronary intervention (4 patients), in patients who were offered LVAD but chose inotropes (15 patients), and for palliation (98 patients). Milrinone was used in 84.8% and dobutamine in 15.2%. At the end of the study, 68 patients had died, 24 were weaned off inotropes, 23 were transplanted, 32 received LVADs, and 50 remained on inotropes. Patients who received inotropes for palliation or those who preferred inotropes over LVAD had median survival of 9.0 months (interquartile range, 3.1-37.1 months), actuarial 1-year survival of 47.6%, and 2-year survival of 38.4%. Of 60 patients who were placed on inotropes as a bridge to transplant/LVAD, 55 were successfully maintained on inotropes until transplant/LVAD. Survival on inotropes for patients who are not candidates for transplant/LVAD is modestly better than previously reported, but remains poor. Inotropes are effective as a bridge to transplant/LVAD. © 2015 American Heart Association, Inc.

  17. Advanced Failure Determination Measurement Techniques Used in Thermal Fatigue Life Testing of Electronic Packaging

    Science.gov (United States)

    Wallace, A. P.; Cornford, S. L.; Gross, M. A.

    1996-01-01

    Thermal fatigue life testing of various electronic packaging technologies is being performed by the Reliability Technology Group at the Jet Propulsion Laboratory. These testing efforts are in progress to improve uderstanding of the reliability issues associated with low volume packaging technologies for space applications and to develop qualification and acceptance approaches for these technologies. The work described here outlines the electrical failure detection techniques used during testing by documenting the circuits and components used to make these measurements, the sensitivity of the measurements, and the applicability of each specific measurement.

  18. Paclitaxel-Based Chemotherapy for Advanced Pancreatic Cancer after Gemcitabine-Based Therapy Failure: A Case Series of 5 Patients

    Directory of Open Access Journals (Sweden)

    Hisato Igarashi

    2011-11-01

    Full Text Available Background/Objectives: Gemcitabine (GEM is a gold-standard chemotherapy agent for advanced pancreatic cancer. Because of the malignant character of the disease, nearly all patients show disease progression despite treatment with GEM-based chemotherapy; therefore, second-line chemotherapy may be beneficial for these patients. We report a retrospective analysis of 5 patients with advanced pancreatic cancer, treated with a paclitaxel-containing regimen as second-, third- or fourth-line chemotherapy after various therapies, such as a GEM-based regimen, S-1 regimen, and chemoradiation. We retrospectively analyzed the efficacy and adverse events, and evaluated the paclitaxel-containing regimens. A review of the literature is also discussed. Results: The median overall survival from the start of salvage therapy was 10.7 months. The disease control rate of the paclitaxel-containing regimen according to RECIST criteria was 60%, including complete response in 0 patients, partial response in 3, and stable disease in 2. Two patients had malignant ascites at the start of this salvage therapy, and in both of them the ascites and clinical complaints improved. Grade 3 and 4 hematological adverse events were observed in 2 patients and 1 patient, respectively. Conclusion: Salvage paclitaxel-based therapy could be beneficial to advanced pancreatic cancer patients who maintain good performance status after several chemotherapy failures.

  19. Investigation of the Failure of Advanced High Strength Steels Heterogeneous Spot Welds

    OpenAIRE

    Thibaut Huin; Sylvain Dancette; Damien Fabrègue; Thomas Dupuy

    2016-01-01

    Nowadays, environmental regulation encourages carmakers to reduce the global vehicle weight. Steelmakers develop grades with high performance (Advanced High Strength Steels, AHSS) and fine steel sheet assemblies are used in car body structures, with an optimized thickness in each part. However, unusual fracture modes are sometimes observed during the mechanical tests of heterogeneous AHSS welds, made of dissimilar steel grades and sheet thicknesses. Weld fractures can occur with a strength lo...

  20. Addressing Achievement Gaps: Advancing Success for Black Men in College. Policy Notes. Volume 22, Number 1, Spring 2015

    Science.gov (United States)

    Yaffe, Deborah

    2015-01-01

    This issue of ETS Policy Notes (Vol. 22, No. 1) provides highlights from a recent symposium sponsored by ETS and the Children Defense Fund (CDF), "Advancing Success for Black Men in College," held on June 23, 2014, in Washington, DC. The symposium is part of a two-conference series: It was the 18th of ETS's "Addressing Achievement…

  1. Management of Advanced Heart Failure in the Elderly: Ethics, Economics, and Resource Allocation in the Technological Era

    Directory of Open Access Journals (Sweden)

    Keith M. Swetz

    2012-01-01

    Full Text Available Significant strides have been made in the durability, portability, and safety of mechanical circulatory support devices (MCS. Although transplant is considered the standard treatment for advanced heart failure, limits in organ availability leave a much larger pool of recipients in need versus donors. MCS is used as bridge to transplantation and as destination therapy (DT for patients who will have MCS as their final invasive therapy with transplant not being an option. Despite improvements in quality of life (QOL and survival, defining the optimal candidate for DT may raise questions regarding the economics of this approach as well as ethical concerns regarding just distribution of goods and services. This paper highlights some of the key ethical issues related to justice and the costs of life-prolonging therapies with respect to resource allocations. Available literature, current debates, and future directions are discussed herein.

  2. Progenitor Hematopoietic Cells Implantation Improves Functional Capacity of End Stage Coronary Artery Disease Patients with Advanced Heart Failure.

    Science.gov (United States)

    Yuniadi, Yoga; Kusnadi, Yuyus; Sandhow, Lakshmi; Erika, Rendra; Hanafy, Dicky A; Sardjono, Caroline; Kaligis, R W M; Kasim, Manoefris; Harimurti, Ganesja M

    2016-01-01

    Background. Proangiogenic Hematopoietic Cells (PHC) which comprise diverse mixture of cell types are able to secrete proangiogenic factors and interesting candidate for cell therapy. The aim of this study was to seek for benefit in implantation of PHC on functional improvement in end stage coronary artery disease patients with advanced heart failure. Methods. Patients with symptomatic heart failure despite guideline directed medical therapy and LVEF less than 35% were included. Peripheral blood mononuclear cells were isolated, cultivated for 5 days, and then harvested. Flow cytometry and cell surface markers were used to characterize PHC. The PHC were delivered retrogradely via sinus coronarius. Echocardiography, myocardial perfusion, and clinical and functional data were analyzed up to 1-year observation. Results. Of 30 patients (56.4 ± 7.40 yo) preimplant NT proBNP level is 5124.5 ± 4682.50 pmol/L. Harvested cells characterized with CD133, CD34, CD45, and KDR showed 0.87 ± 0.41, 0.63 ± 0.66, 99.00 ± 2.60, and 3.22 ± 3.79%, respectively. LVEF was improved (22 ± 5.68 versus 26.8 ± 7.93, p observation. Myocardial perfusion significantly improved 6 months after treatment. NYHA Class and six-minute walk test are improved during short term and long term follow-up. Conclusion. Expanded peripheral blood PHC implantation using retrograde delivery approach improved LV systolic function, myocardial perfusion, and functional capacity.

  3. Stamping failure analysis of advanced high strength steel sheet based on non-uniform local deformation through thickness

    Science.gov (United States)

    Huang, Sheng; Zhao, Yixi; He, Chunfeng

    2013-12-01

    The phenomenon "Shear fracture" is often observed in the stretch-bending process of stamping over small radius with advanced high strength steels (AHSS). It occurs parallel to and near the die radius in the stretch-bending test. Since traditional Forming Limit Diagram (FLD) is unable to describe this type of failure, experimental and simulation works were constructed in this paper to investigate and predict the shear fracture. Fracture experiments were carried out through a stretch-bending test system, and failure mode was observed. There is no obviously thinning at the shear fracture surface. Further research shows that the initial crack of shear fracture occurs at the outer layer of specimen at die radius position. Finite element (FE) models were built for stretch-bending test with 3D element. The non-uniform local deformation through thickness corresponding to bending position was obtained and analyzed. Cockcroft & Latham fracture criterion is used. The outer layer of specimen at bending position reaches the critical fracture state firstly, which agrees well with experiments. Different fracture criteria are also compared and selected to determine this fracture. Results show that based on the non-uniform local deformation, the initial crack location of shear fracture at small radius can be effectively predicted by fracture criteria related to the maximum principle stress.

  4. Survival and failure outcomes in locally advanced esthesioneuroblastoma: a single centre experience of 15 patients.

    Science.gov (United States)

    Kumar, Ritesh; Ghoshal, Sushmita; Khosla, Divya; Bharti, Shreekant; Das, Ashim; Kumar, Narendra; Kapoor, Rakesh; Sharma, Suresh Chander

    2013-05-01

    Esthesioneuroblastoma (ENB) constitutes 3 % of all malignant intranasal tumors. As the tumor is very rare, the number of patients of ENB treated in individual departments is small. We present our institute's experience in combined modality management of 15 successive patients of ENB treated from 2006 to 2010. Clinical characteristics and treatment modality in form of surgery, radiotherapy and chemotherapy were noted. Kadish stage C was the most common stage (12 patients) followed by stage B (3 patients). Fourteen patients underwent primary surgery, of which nine had total excision and five had subtotal excision. One patient was treated with combination of chemotherapy (CT) and radiotherapy (RT). Median RT dose delivered was 54 Gy. Twelve patients received CT with cisplatin and etoposide. Overall, eight patients had complete response, five had partial response, while one had static disease and progressive disease each. Two patients had distant metastases. Four-year loco-regional control (LRC) was 25 % and 4-year overall survival (OS) was 45 %. Most common presentation in our series was locally advanced tumors. Most of these patients require adjuvant RT, which helps in significant LRC. Systemic CT benefits in inoperable, advanced and high risk tumors. Risk-adapted and multimodality approach is the need of hour to achieve good control rates while minimizing treatment related toxicity.

  5. Advances in the management of heart failure: the role of ivabradine

    Directory of Open Access Journals (Sweden)

    Müller-Werdan U

    2016-11-01

    Full Text Available Ursula Müller-Werdan,1,2 Georg Stöckl,3 Karl Werdan4 1Charité – Universitätsmedizin Berlin, 2Protestant Geriatric Centre, Berlin, 3Department of Medical Affairs, Servier Deutschland GmbH, Munich, 4Department of Medicine III, University Hospital Halle (Saale, Martin-Luther-University Halle‑Wittenberg, Halle (Saale, Germany Abstract: A high resting heart rate (≥70–75 b.p.m. is a risk factor for patients with heart failure (HF with reduced ejection fraction (EF, probably in the sense of accelerated atherosclerosis, with an increased morbidity and mortality. Beta-blockers not only reduce heart rate but also have negative inotropic and blood pressure-lowering effects, and therefore, in many patients, they cannot be given in the recommended dose. Ivabradine specifically inhibits the pacemaker current (funny current, If of the sinoatrial node cells, resulting in therapeutic heart rate lowering without any negative inotropic and blood pressure-lowering effect. According to the European Society of Cardiology guidelines, ivabradine should be considered to reduce the risk of HF hospitalization and cardiovascular death in symptomatic patients with a reduced left ventricular EF ≤35% and sinus rhythm ≥70 b.p.m. despite treatment with an evidence-based dose of beta-blocker or a dose below the recommended dose (recommendation class “IIa” = weight of evidence/opinion is in favor of usefulness/efficacy: “should be considered”; level of evidence “B” = data derived from a single randomized clinical trial or large nonrandomized studies. Using a heart rate cutoff of ≥ 75 b.p.m., as licensed by the European Medicines Agency, treatment with ivabradine 5–7.5 mg b.i.d. reduces cardiovascular mortality by 17%, HF mortality by 39% and HF hospitalization rate by 30%. A high resting heart rate is not only a risk factor in HF with reduced EF but also at least a risk marker in HF with preserved EF, in acute HF and also in special forms of HF

  6. Piloting an advanced methodology to analyse health care policy networks: The example of Belgrade, Serbia

    Directory of Open Access Journals (Sweden)

    Helmut Wenzel

    2015-11-01

    Full Text Available Aim: Political decisions usually emerge from the competing interests of politicians, voters, and special interest groups. We investigated the applicability of an advanced methodological concept to determine whether certain institutional positions in a cooperating network have influence on the decision-making procedures. To that end, we made use of the institutional network of relevant health care and health governance institutions, concentrated in Belgrade, Serbia. Methods: We used a Principal Component Analysis (PCA based on a combination of measures for centrality in order to evaluate the positions of 25 players in Belgrade‟s institutional network. Their directed links were determined by a simulated position approach employing the authors‟ long-term involvement. Software packages used consisted of Visone 2.9, UCINET 6, and KeyPlayer 1.44. Results: In our analysis, the network density score in Belgrade was 71%. The PCA revealed two dimensions: control and attractiveness. The Ministry of Health exerted the highest level of control but displayed a low attractiveness in terms of receiving links from important players. The National Health Insurance Fund had less control capacity but a high attractiveness. The National Institute of Public Health‟s position was characterized by a low control capacity and high attractiveness, whereas the National Drug Agency, the National Health Council, and Non-Governmental Organisations were no prominent players. Conclusions: The advanced methodologies used here to analyse the health care policy network in Belgrade provided consistent results indicating that the intended decentralization of the health care network in Belgrade may be incomplete, still with low participation of civil society representatives. With the present study we set the stage for a broad-range survey based data collection applying the methodology piloted in Belgrade.

  7. Acute electromyostimulation decreases muscle sympathetic nerve activity in patients with advanced chronic heart failure (EMSICA Study.

    Directory of Open Access Journals (Sweden)

    Marc Labrunée

    Full Text Available BACKGROUND: Muscle passive contraction of lower limb by neuromuscular electrostimulation (NMES is frequently used in chronic heart failure (CHF patients but no data are available concerning its action on sympathetic activity. However, Transcutaneous Electrical Nerve Stimulation (TENS is able to improve baroreflex in CHF. The primary aim of the present study was to investigate the acute effect of TENS and NMES compared to Sham stimulation on sympathetic overactivity as assessed by Muscle Sympathetic Nerve Activity (MSNA. METHODS: We performed a serie of two parallel, randomized, double blinded and sham controlled protocols in twenty-two CHF patients in New York Heart Association (NYHA Class III. Half of them performed stimulation by TENS, and the others tested NMES. RESULTS: Compare to Sham stimulation, both TENS and NMES are able to reduce MSNA (63.5 ± 3.5 vs 69.7 ± 3.1 bursts / min, p < 0.01 after TENS and 51.6 ± 3.3 vs 56.7 ± 3.3 bursts / min, p < 0, 01 after NMES. No variation of blood pressure, heart rate or respiratory parameters was observed after stimulation. CONCLUSION: The results suggest that sensory stimulation of lower limbs by electrical device, either TENS or NMES, could inhibit sympathetic outflow directed to legs in CHF patients. These properties could benefits CHF patients and pave the way for a new non-pharmacological approach of CHF.

  8. Adjunctive treatment with moxonidine versus nitrendipine for hypertensive patients with advanced renal failure: a cost-effectiveness analysis

    Directory of Open Access Journals (Sweden)

    Baum Dominique

    2007-07-01

    Full Text Available Abstract Background Systemic hypertension often accompanies chronic renal failure and can accelerate its progression to end-stage renal disease (ESRD. Adjunctive moxonidine appeared to have benefits versus adjunctive nitrendipine, in a randomised double-blind six-month trial in hypertensive patients with advanced renal failure. To understand the longer term effects and costs of moxonidine, a decision analytic model was developed and a cost-effectiveness analysis performed. Methods A Markov model was used to extrapolate results from the trial over three years. All patients started in a non-ESRD state. After each cycle, patients with a glomerular filtration rate below 15 ml/min had progressed to an ESRD state. The cost-effectiveness analysis was based on the Dutch healthcare perspective. The main outcome measure was incremental cost per life-year gained. The percentage of patients progressing to ESRD and cumulative costs were also compared after three years. In the base case analysis, all patients with ESRD received dialysis. Results The model predicted that after three years, 38.9% (95%CI 31.8–45.8 of patients treated with nitrendipine progressed to ESRD compared to 7.5% (95%CI 3.5–12.7 of patients treated with moxonidine. Treatment with standard antihypertensive therapy and adjunctive moxonidine was predicted to reduce the number of ESRD cases by 81% over three years compared to adjunctive nitrendipine. The cumulative costs per patient were significantly lower in the moxonidine group €9,858 (95% CI 5,501–16,174 than in the nitrendipine group €37,472 (95% CI 27,957–49,478. The model showed moxonidine to be dominant compared to nitrendipine, increasing life-years lived by 0.044 (95%CI 0.020–0.070 years and at a cost-saving of €27,615 (95%CI 16,894–39,583 per patient. Probabilistic analyses confirmed that the moxonidine strategy was dominant over nitrendipine in over 98.9% of cases. The cumulative 3-year costs and LYL continued to

  9. Dimensions of religiousness and spirituality as predictors of well-being in advanced chronic heart failure patients.

    Science.gov (United States)

    Park, Crystal L; Lim, Haikel; Newlon, Max; Suresh, D P; Bliss, Deborah E

    2014-04-01

    We examined relationships between seven dimensions of religion/spirituality (RS) (forgiveness, daily spiritual experiences, belief in afterlife, religious identity, religious support, public practices, and positive RS coping) and three dimensions of well-being (physical, mental, and existential) in a sample of 111 patients with advanced chronic heart failure. Participants completed questionnaires at baseline and 3 months later. Results showed that fairly high levels of RS were reported on all seven dimensions. Furthermore, RS dimensions were differentially related to well-being. No aspect of RS was related to physical well-being, and only a few aspects were related to mental well-being. Forgiveness was related to less subsequent depression, while belief in afterlife was related to poorer mental health. All aspects of RS were related to at least one aspect of existential well-being. In particularly, daily spiritual experiences were linked with higher existential well-being and predicted less subsequent spiritual strain. These results are consistent with the view that in advanced disease, RS may not affect physical well-being but may have potent influences on other aspects of well-being, particularly existential aspects.

  10. Advances in the management of heart failure: the role of ivabradine.

    Science.gov (United States)

    Müller-Werdan, Ursula; Stöckl, Georg; Werdan, Karl

    2016-01-01

    A high resting heart rate (≥70-75 b.p.m.) is a risk factor for patients with heart failure (HF) with reduced ejection fraction (EF), probably in the sense of accelerated atherosclerosis, with an increased morbidity and mortality. Beta-blockers not only reduce heart rate but also have negative inotropic and blood pressure-lowering effects, and therefore, in many patients, they cannot be given in the recommended dose. Ivabradine specifically inhibits the pacemaker current (funny current, If) of the sinoatrial node cells, resulting in therapeutic heart rate lowering without any negative inotropic and blood pressure-lowering effect. According to the European Society of Cardiology guidelines, ivabradine should be considered to reduce the risk of HF hospitalization and cardiovascular death in symptomatic patients with a reduced left ventricular EF ≤35% and sinus rhythm ≥70 b.p.m. despite treatment with an evidence-based dose of beta-blocker or a dose below the recommended dose (recommendation class "IIa" = weight of evidence/opinion is in favor of usefulness/efficacy: "should be considered"; level of evidence "B" = data derived from a single randomized clinical trial or large nonrandomized studies). Using a heart rate cutoff of ≥ 75 b.p.m., as licensed by the European Medicines Agency, treatment with ivabradine 5-7.5 mg b.i.d. reduces cardiovascular mortality by 17%, HF mortality by 39% and HF hospitalization rate by 30%. A high resting heart rate is not only a risk factor in HF with reduced EF but also at least a risk marker in HF with preserved EF, in acute HF and also in special forms of HF. In this review, we discuss the proven role of ivabradine in the validated indication "HF with reduced EF" together with interesting preliminary findings, and the potential role of ivabradine in further, specific forms of HF.

  11. Within-day test-retest reliability of the Timed Up & Go test in patients with advanced chronic organ failure.

    Science.gov (United States)

    Mesquita, Rafael; Janssen, Daisy J A; Wouters, Emiel F M; Schols, Jos M G A; Pitta, Fabio; Spruit, Martijn A

    2013-11-01

    To investigate the within-day test-retest reliability of the Timed Up & Go (TUG) test in patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and chronic renal failure (CRF). Cross-sectional. Patients' home environment. Subjects (N=235, 64% men; median age, 70y [interquartile range, 61-77y]; median body mass index, 25.6kg/m(2) [interquartile range, 22.8-29.4kg/m(2)]) with advanced COPD (n=95), CHF (n=68), or CRF (n=72). Not applicable. Time to complete the TUG test. Three trials were performed on the same day and by the same assessors. The intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement, and absolute and relative minimal detectable change (MDC) values were calculated. Good agreement was observed, in general, for both the total sample and subgroups (COPD, CHF, CRF), with ICC values ranging from .85 to .98, and kappa coefficients from .49 to 1.00. However, statistical improvement occurred in the total sample from the first to the second trial with large limits of agreement (mean difference, -.97s; 95% confidence interval, 3.00 to -4.94s; P<.01). The third trial added little or no information to the first 2 trials. For the total sample, a standard error of measurement value of approximately 1.6 seconds, an absolute value of MDC at the 95% confidence level (MDC95%) of approximately 4.5 seconds, and a relative value of MDC at the 95% confidence level (MDC95%%) of approximately 35% were found between the first 2 trials, with similar values found for the subgroups. The TUG test is reliable in patients with advanced COPD, CHF, or CRF after 2 trials. Values of standard error of measurement and MDC may be used in daily clinical practice with these populations to define what is expected and what represents true change in repeated measures. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. Exo-organoplasty interventions: A brief review of past, present and future directions for advance heart failure management.

    Science.gov (United States)

    Nawaz, Waqas; Khan, Farhan Ullah; Khan, Muhammad Zahid; Gang, Wang; Yang, Mengqi; Liao, Xiaoqian; Zhang, Li; Ihsan, Awais Ullah; Khan, Amjad; Han, Lei; Zhou, Xiaohui

    2017-04-01

    Heart failure (HF) is a debilitating disease in which abnormal function of the heart leads to imbalance of blood demand to tissues and organs. The pathogenesis of HF is very complex and various factors can contribute including myocardial infarction, ischemia, hypertension and genetic cardiomyopathies. HF is the leading cause of death and its prevalence is expected to increase in parallel with the population age. Different kind of therapeutic approaches including lifestyle modification, medication and pacemakers are used for HF patients in NYHA I-III functional class. However, for advance stage HF patient's (NYHA IV), ventricle assist devices are clinically use and stem cells are under active investigation. Most of these therapies leads to modest symptoms relief and have no significant role in long-term survival rate. Currently there is no effective treatment for advance HF except heart transplantation, which is still remain clinically insignificant because of donor pool limitation. As HF is a result of multiple etiologies therefore multi-functional therapeutic platform is needed. Exo-organoplasty interventions are studied from almost one century. The major goals of these interventions are to treat various kind of heart disease from outside the heart muscle without having direct contact with blood. Various kind of interventions (devices and techniques) are developed in this arena with the passage of time. The purpose of this review is to describe the theory behind intervention devices, the devices themselves, their clinical results, advantages and limitations. Furthermore, to present a future multi-functional therapeutic platform (ASD) for advance stage HF management. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Human Cardiosphere-Derived Cells From Advanced Heart Failure Patients Exhibit Augmented Functional Potency in Myocardial Repair

    Science.gov (United States)

    Shen, Deliang; Sun, Baiming; Blusztajn, Agnieszka; Xie, Yucai; Ibrahim, Ahmed; Aminzadeh, Mohammad Amin; Liu, Weixin; Li, Tao-Sheng; De Robertis, Michele A.; Marbán, Linda; Czer, Lawrence S. C.; Trento, Alfredo; Marbán, Eduardo

    2014-01-01

    Objectives This study sought to compare the regenerative potency of cells derived from healthy and diseased human hearts. Background Results from pre-clinical studies and the CADUCEUS (CArdiosphere-Derived aUtologous stem CElls to reverse ventricUlar dySfunction) trial support the notion that cardiosphere-derived cells (CDCs) from normal and recently infarcted hearts are capable of regenerating healthy heart tissue after myocardial infarction (MI). It is unknown whether CDCs derived from advanced heart failure (HF) patients retain the same regenerative potency. Methods In a mouse model of acute MI, we compared the regenerative potential and functional benefits of CDCs derived from 3 groups: 1) non-failing (NF) donor: healthy donor hearts post-transplantation; 2) MI: patients who had an MI 9 to 35 days before biopsy; and 3) HF: advanced cardiomyopathy tissue explanted at cardiac transplantation. Results Cell growth and phenotype were identical in all 3 groups. Injection of HF CDCs led to the greatest therapeutic benefit in mice, with the highest left ventricular ejection fraction, thickest infarct wall, most viable tissue, and least scar 3 weeks after treatment. In vitro assays revealed that HF CDCs secreted higher levels of stromal cell-derived factor 1 (SDF-1), which may contribute to the cells’ augmented resistance to oxidative stress, enhanced angiogenesis, and improved myocyte survival. Histological analysis indicated that HF CDCs engrafted better, recruited more endogenous stem cells, and induced greater angiogenesis and cardiomyocyte cell-cycle re-entry. CDC-secreted SDF-1 levels correlated with decreases in scar mass over time in CADUCEUS patients treated with autologous CDCs. Conclusions CDCs from advanced HF patients exhibit augmented potency in ameliorating ventricular dysfunction post-MI, possibly through SDF-1–mediated mechanisms. PMID:24511463

  14. Serum From Advanced Heart Failure Patients Promotes Angiogenic Sprouting and Affects the Notch Pathway in Human Endothelial Cells.

    Science.gov (United States)

    Pannella, Micaela; Caliceti, Cristiana; Fortini, Francesca; Aquila, Giorgio; Vieceli Dalla Sega, Francesco; Pannuti, Antonio; Fortini, Cinzia; Morelli, Marco Bruno; Fucili, Alessandro; Francolini, Gloria; Voltan, Rebecca; Secchiero, Paola; Dinelli, Giovanni; Leoncini, Emanuela; Ferracin, Manuela; Hrelia, Silvana; Miele, Lucio; Rizzo, Paola

    2016-12-01

    It is unknown whether components present in heart failure (HF) patients' serum provide an angiogenic stimulus. We sought to determine whether serum from HF patients affects angiogenesis and its major modulator, the Notch pathway, in human umbilical vein endothelial cells (HUVECs). In cells treated with serum from healthy subjects or from patients at different HF stage we determined: (1) Sprouting angiogenesis, by measuring cells network (closed tubes) in collagen gel. (2) Protein levels of Notch receptors 1, 2, 4, and ligands Jagged1, Delta-like4. We found a higher number of closed tubes in HUVECs treated with advanced HF patients serum in comparison with cells treated with serum from mild HF patients or controls. Furthermore, as indicated by the reduction of the active form of Notch4 (N4IC) and of Jagged1, advanced HF patients serum inhibited Notch signalling in HUVECs in comparison with mild HF patients' serum and controls. The circulating levels of NT-proBNP (N-terminal of the pro-hormone brain natriuretic peptide), a marker for the detection and evalutation of HF, were positively correlated with the number of closed tubes (r = 0.485) and negatively with Notch4IC and Jagged1 levels in sera-treated cells (r = -0.526 and r = -0.604, respectively). In conclusion, we found that sera from advanced HF patients promote sprouting angiogenesis and dysregulate Notch signaling in HUVECs. Our study provides in vitro evidence of an angiogenic stimulus arising during HF progression and suggests a role for the Notch pathway in it. J. Cell. Physiol. 231: 2700-2710, 2016. © 2016 Wiley Periodicals, Inc.

  15. Progenitor Hematopoietic Cells Implantation Improves Functional Capacity of End Stage Coronary Artery Disease Patients with Advanced Heart Failure

    Directory of Open Access Journals (Sweden)

    Yoga Yuniadi

    2016-01-01

    Full Text Available Background. Proangiogenic Hematopoietic Cells (PHC which comprise diverse mixture of cell types are able to secrete proangiogenic factors and interesting candidate for cell therapy. The aim of this study was to seek for benefit in implantation of PHC on functional improvement in end stage coronary artery disease patients with advanced heart failure. Methods. Patients with symptomatic heart failure despite guideline directed medical therapy and LVEF less than 35% were included. Peripheral blood mononuclear cells were isolated, cultivated for 5 days, and then harvested. Flow cytometry and cell surface markers were used to characterize PHC. The PHC were delivered retrogradely via sinus coronarius. Echocardiography, myocardial perfusion, and clinical and functional data were analyzed up to 1-year observation. Results. Of 30 patients (56.4±7.40 yo preimplant NT proBNP level is 5124.5±4682.50 pmol/L. Harvested cells characterized with CD133, CD34, CD45, and KDR showed 0.87±0.41, 0.63±0.66, 99.00±2.60, and 3.22±3.79%, respectively. LVEF was improved (22±5.68 versus 26.8±7.93, p<0.001 during short and long term observation. Myocardial perfusion significantly improved 6 months after treatment. NYHA Class and six-minute walk test are improved during short term and long term follow-up. Conclusion. Expanded peripheral blood PHC implantation using retrograde delivery approach improved LV systolic function, myocardial perfusion, and functional capacity.

  16. Retreatment with Epidermal Growth Factor Receptor Inhibitor After Initial Failure in Advanced Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Tongtong AN

    2011-03-01

    Full Text Available Background and objective The epidermal growth factor receptor tyrosine kinase inhibitor (EGFRTKI shows favorable antitumor activity against chemorefractory non-small cell lung cancer (NSCLC. However, patients with advanced NSCLC have limited treatment options available if they are refractory to EGFR-TKI. To study the influence of the retreatment EGFR-TKI after failure of first-line TKI, we carried out this retrospective study. Methods Total 71 patients were analyzed who experienced treatment failure from their initial use of EGFR-TKI. After a period of time, they were retreated with TKI as tumor progression was observed. Results Of the 71 patients who received retreatment TKI, it was observed in 7% in partial response (PR, 36.6% in stable disease (SD, 56.3% in progressive disease (PD. Disease control rate (DCR was 43.7%. Twenty-six (36.6% patients were well controlled by retreatment with TKI monotherapy for not less than 3 months. Five (7.0% patients had partial response. Exon 21 mutation, PFS not less than 6 months during initial treatment TKI, and the interval not less than 3 months between initial treatment, and retreatment with TKI was associated with a good progression free survival based on univariate COX analysis (P=0.034; P=0.013; P=0.046. Conclusion It has been shown the possibility that retreatment with TKI might be useful when (1 Exon 21 has active mutation, (2 initial treatment shows a favorable PFS (≥ 6 months, and (3 there has been a period of time (≥3 months following the termination of the initial TKI treatment.

  17. Effectiveness of beta-blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect-modification by age?

    NARCIS (Netherlands)

    Dobre, D.; deJongste, M.J.L.; Lucas, C.; Cleuren, G.; van Veldhuisen, D.J.; Ranchor, A.V.; Haaijer-Ruskamp, F.

    2007-01-01

    Aims The effects of beta-blockers in daily practice patients with advanced chronic heart failure (CHF) and a broad range of ejection fraction (EF) are not well established. We aimed to assess, first, the association between beta-blocker prescription at discharge and mortality in a cohort of patients

  18. Predictive value of advanced glycation end products for the development of post-infarction heart failure: a preliminary report

    Directory of Open Access Journals (Sweden)

    Raposeiras-Roubín Sergio

    2012-08-01

    Full Text Available Abstract Background Since post-infarction heart failure (HF determines a great morbidity and mortality, and given the physiopathology implications of advanced glycation end products (AGE in the genesis of myocardial dysfunction, it was intended to analyze the prognostic value of these molecules in order to predict post-infarction HF development. Methods A prospective clinical study in patients after first acute coronary syndrome was conducted. The follow-up period was consisted in 1 year. In 194 patients consecutively admitted in the coronary unit for myocardial infarct fluorescent AGE levels were measured. The association between glycaemic parameters and the development of post-infarction HF were analyzed in those patients. Finally, we identified the variables with independent predictor value by performing a multivariate analysis of Hazard ratio for Cox regression. Results Eleven out of 194 patients (5.6% developed HF during follow-up (median: 1.0 years [0.8 - 1.5 years]. Even though basal glucose, fructosamine and glycated haemoglobin were significant predictive factors in the univariate analysis, after being adjusted by confounding variables and AGE they lost their statistical signification. Only AGE (Hazard Ratio 1.016, IC 95%: 1.006-1.026; p Conclusions AGE are an independent marker of post-infarction HF development risk.

  19. CRAVING FOR BALANCED PUBLIC DECISION-MAKING ON MARKET FAILURE PERTAINING TO THE INTERVENTIONIST ECONOMIC POLICIES STRAINER

    Directory of Open Access Journals (Sweden)

    Bitoiu Teodora

    2015-07-01

    Full Text Available The research proposes a topic of very high interest for both our national economy and the European economy as it refers to the negative externalities and their role in the economic theory of subsidiarity developed as part of the multilevel governance. The case of the negative externalities represents one of the six situations of market interventions (due to the non Pareto efficient status and, moreover, their specific case (pollution is on the priority list of the European Union (Treaty establishing the European Community (Art. 174/130r – EC Treaty establishing the polluter pays principle (PPP. Romania does not have a broad experience in this area (as it is also a new Member State or if it has it is one that has confirmed our lack of expertise (e.g. the case of the eco-duty. In order to contribute to knowledge building in this field, the project aims at developing a methodology in the area of public decision-making for a particular market failure (externalities/spillovers by appealing to the instruments provided by the multilevel governance vision and its subsidiarity principle so to provide a more efficient relationship between the costs and the benefits of a solid environmental policy. This methodology, imagined as a decision map, must provide a correspondence between the procedural part of the decision-making (correlating the national and the European level and the formal part consisting in a formula that weights the elements that the research finds important. This particular manuscript is a work-in-progress as it puts forward the results we have reached so far as part of a post-doctoral research. The work proves valuable as it substantiates the theoretical framework needed for the final part of the research, which will be testing the decision map. Consequently, this research was undertaken by foraying the field literature and challenging the findings on a theoretical level. It must be underlined that the findings are purely speculative and

  20. Advancing Public Policy for High-Growth, Female, and Social Entrepreneurs

    NARCIS (Netherlands)

    Bosma, N.S.; Stam, F.C.; Terjesen, Siri Ann

    2016-01-01

    Findings from a large and growing body of entrepreneurship research offer insights for public policy and public officials and managers. Entrepreneurship policy is defined as measures undertaken to stimulate entrepreneurship in a region or country. The authors discuss generalizations from empirical r

  1. Chartering Equity: Using Charter School Legislation and Policy to Advance Equal Educational Opportunity

    Science.gov (United States)

    Mead, Julie F.; Green, Preston C., III

    2012-01-01

    This policy brief addresses the challenge of using charter school policy to enhance equal educational opportunity. Three overriding assumptions guide the brief's recommendations: (1) charter schools will be part of our public educational system for the foreseeable future; (2) charter schools are neither inherently good, nor inherently bad; and (3)…

  2. Pathways to Advancing Aging Policy-Relevant Research in Academic Settings

    Science.gov (United States)

    KIETZMAN, KATHRYN G.; TROY, LISA M.; GREEN, CARMEN R.; WALLACE, STEVEN P.

    2016-01-01

    Policy-level changes have a significant influence on the health and well-being of aging populations. Yet there is often a gap between scientific knowledge and policy action. Although previous research has identified barriers and facilitators to effective knowledge translation, little attention has been given to the role of academic institutions in knowledge generation. This exploratory focus group study examines barriers and pathways to developing and maintaining an aging policy-relevant research agenda in academic settings, and additional challenges associated with minority group membership in this pursuit. Participants were personally committed to conducting policy-relevant research despite institutional barriers such as fewer funding opportunities and less value attributed to their research, particularly in the context of tenure and promotion. Although many viewed their research as an opportunity to make a difference, especially for underserved older adult populations, a number of minority group participants expressed that their policy research interests were marginalized. Participants offer individual and institutional-level strategies for addressing barriers, including collaborating with community members and colleagues and engaging mentors within and outside of their academic institutions. Reframing the valuation of policy research through the diversification of funding and publishing opportunities can better support scholars engaged in aging policy-relevant research. PMID:26849290

  3. Harmonisation of European Migration Policies: The Failure of Immigration Control Policies in the Seventh and Eighth Decades of the 20th Century

    Directory of Open Access Journals (Sweden)

    Milan Mesić

    2003-12-01

    Full Text Available Until the middle of the 1970s, the migration policies of developed European countries were based on the assumption that controlling immigration was possible. Due to various reasons discussed in this article, such policies proved unsuccessful. The result was an increase in the total number of foreigners and a change in the composition of immigrant communities, i.e. the proportion of supported family members increased. During the 1980s there was increasing convergence in the migration policies of European immigration countries and traditional overseas emigration countries. Policies were more and more oriented towards preventing illegal migration flows, on regulating refugee flows and on balancing labour migration with family migration. The turning-point in the direction of “harmonising” West European migration policies was marked by the Schengen agreement (1985 on gradual elimination of border controls between the signing parties (France, Germany and the Benelux countries. Fear in the face of a possible invasion of Eastern Europeans after the collapse of socialism in 1989 was a further strong stimulus towards the harmonisation of migration policies in the developing EU. As opposed to migration control, the integration of immigrants has remained so far the prerogative of nation-states. The text further presents an overview of migration policy reforms in individual member states of the EU and of multilateral actions. The post-1989 migration regime in Europe has four major traits: 1 an extension of the agenda; 2 an accent on joint actions; 3 defensiveness; 4 confusion and an overload of issues. While on the one hand the EU continues to seek ways of protecting itself from undesired external migration, on the other hand the process of regional integration continues to “erase” its internal borders.

  4. The outcome and predictive factors of sunitinib therapy in advanced gastrointestinal stromal tumors (GIST after imatinib failure - one institution study

    Directory of Open Access Journals (Sweden)

    Rutkowski Piotr

    2012-03-01

    Full Text Available Abstract Background Gastrointestinal stromal tumors (GIST mutational status is recognized factor related to the results of tyrosine kinase inhibitors therapy such as imatinib (IM or sunitinib (SU. Arterial hypertension (AH is common adverse event related to SU, reported as predictive factor in renal cell carcinoma. The aim of the study was to analyze the outcomes and factors predicting results of SU therapy in inoperable/metastatic CD117(+ GIST patients after IM failure. Methods We identified 137 consecutive patients with advanced inoperable/metastatic GIST treated in one center with SU (2nd line treatment. Median follow-up time was 23 months. Additionally, in 39 patients there were analyzed selected constitutive single nucleotide polymorphisms (SNPs of VEGFA and VEGFR2 genes. Results One year progression-free survival (PFS; calculated from the start of SU rate was 42% and median PFS was 43 weeks. The estimated overall survival (OS, calculated both from start of SU or IM was 74 weeks and 51 months, respectively. One-year PFS was 65% (median 74 weeks in 55 patients with AH vs. 22% (median 17 weeks in patients without AH. Patients with primary tumors carrying mutations in KIT exon 9 or wild-type had substantially better 1-year PFS (68% and 57%; median 65.5 and 50.5 weeks, respectively than patients having tumors with KIT exon 11 or PDGFRA mutations (34% and 15%; median 36.8 and 9 weeks, respectively. We identified two independent factors with significant impact on PFS and OS in univariate and multivariate analysis: primary tumor genotype and presence of AH. The most common adverse events during therapy were: fatigue, AH, hypothyroidism, hand and foot syndrome, mucositis, skin reactions, dyspepsia, and diarrhea. Two deaths were assessed as related to tumor rupture caused by reaction to SU therapy. The presence of C-allele in rs833061 and the T-allele in rs3025039 polymorphism of VEGFA were associated with significantly higher risk of hypothyroidism

  5. Reduced chronotropic reserve to the metabolic requirement during exercise in advanced heart failure with old myocardial infarction.

    Science.gov (United States)

    Yamabe, H; Kobayashi, K; Takata, T; Fukuzaki, H

    1987-03-01

    We studied the metabolic and cardiac responses to exercise by expiratory gas analysis in 40 patients with old myocardial infarction and 33 normal sedentary males. On the basis of exercise energy metabolism, the elevation of the respiratory quotient (RQ; RQ = VCO2/VO2) during exercise is caused by the increase of blood lactate due to the augmented anaerobic metabolism. Functional aerobic impairment (FAI) in our study was significantly advanced in the control group and the NYHA functional class I, class II and class III groups, that is, -2.3 +/- 11.2%, +14.8 +/- 10.4%, +27.8 +/- 13.8% and +49.4 +/- 2.8%, respectively. The delta RQ values were similar among all groups; 0.29 respectively. The delta RQ values were similar among all groups; 0.29 +/- 0.06, 0.28 +/- 0.07, 0.27 +/- 0.07 and 0.29 +/- 0.09, respectively. Functional chronotropic impairment (FCI) for the same groups was -0.9 +/- 7.0%, +1.4 6.1%, +3.8 +/- 4.8% and +8.7 +/- 6.0%, and that of the class III group was significantly larger than that of the control group. Thus, in the class III congestive heart failure group, the chronotropic response to the metabolic requirement was impaired in comparison to the control group. It was concluded that the reduced chronotropic reserve was present in NYHA class III patients with old myocardial infarction, and that this mechanism might contribute to a decrease in the pump reserve of the heart, resulting in further impairment of physical capacity in these patients.

  6. Malta’s Tourism Policy: Standing Still or Advancing towards Sustainability?

    Directory of Open Access Journals (Sweden)

    Rachel Dodds

    2007-05-01

    Full Text Available As with most warm water islands, Malta’s tourism has been historically focused towards sun, sea and sand package holidays. As a result, the ratio of visitors to locals has expanded very quickly and the strain on infrastructure from too many tourists is evident. As do other small islands, Malta also suffers from an absence of pluralism amongst the political-economic elite and a familiarity between voters and politicians, thereby creating barriers to implementing successful policies. Through an examination of how successful tourism policy implementation has been to date, this paper examines Malta’s tourism development as it relates to sustainable tourism. The paper addresses the economic, social and political implications of tourism development as well as discusses barriers to implementing a tourism policy specifically geared to sustainability. The paper concludes by providing insights into sustainable tourism policy implementation issues for other island destinations.

  7. Advancing Open 3D Modelling Standards in National Spatial Information Policy

    NARCIS (Netherlands)

    Trakas, A.; Janssen, P.; Stoter, J.

    2012-01-01

    Individuals and organisations around the world - facing extraordinary challenges and new opportunities - are together engaged in numerous projects, involving natural and built environments. Spatial information policy is at the heart of these projects. The information technologies available enable in

  8. Role for Occupational Therapy in Community Mental Health: Using Policy to Advance Scholarship of Practice.

    Science.gov (United States)

    Mahaffey, Lisa; Burson, Kathrine A; Januszewski, Celeste; Pitts, Deborah B; Preissner, Katharine

    2015-01-01

    Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.

  9. Advancing science and policy through a coordinated international study of physical activity and built environments

    DEFF Research Database (Denmark)

    Kerr, Jacqueline; Sallis, James F; Owen, Neville;

    2013-01-01

    National and international strategies to increase physical activity emphasize environmental and policy changes that can have widespread and long-lasting impact. Evidence from multiple countries using comparable methods is required to strengthen the evidence base for such initiatives. Because some...... environment and policy changes could have generalizable effects and others may depend on each country's context, only international studies using comparable methods can identify the relevant differences....

  10. Effects of percutaneous mitral valve repair with Mitraclip on clinical status, ventricular remodeling and neurohormonal profile in patients with advanced heart failure and significant functional mitral regurgitation

    OpenAIRE

    Berardini, Alessandra

    2016-01-01

    The role of percutaneous mitral valve repair (PMVR) in patients with advanced heart failure (HF) and functional mitral regurgitation (FMR) is unclear. The aim of this study was to assess the effects (PMVR) therapy on clinical outcomes , left ventricular (LV) remodeling and neurohormonal changes in inoperable critical patients with chronically symptomatic FMR despite optical medical /electrical therapy and severe LV dysfunction. We analyzed the clinical and echocardiographic data of twenty-fiv...

  11. Challenges and Benefits of Direct Policy Search in Advancing Multiobjective Reservoir Management

    Science.gov (United States)

    Castelletti, Andrea; Giuliani, Matteo; Zatarain-Salazar, Jazmin; Hermann, John; Pianosi, Francesca; Reed, Patrick

    2015-04-01

    Optimal management policies for water reservoir operation are generally designed via stochastic dynamic programming (SDP). Yet, the adoption of SDP in complex real-world problems is challenged by the three curses of dimensionality, of modeling, and of multiple objectives. These three curses considerably limit SDP's practical application. Alternatively, in this study, we focus on the use of evolutionary multi-objective direct policy search (EMODPS), a simulation-based optimization approach that combines direct policy search, nonlinear approximating networks and multi-objective evolutionary algorithms to design Pareto approximate operating policies for multi-purpose water reservoirs. Our analysis explores the technical and practical implications of using EMODPS through a careful diagnostic assessment of the EMODPS Pareto approximate solutions attained and the overall reliability of the policy design process. A key choice in the EMODPS approach is the selection of alternative formulations of the operating policies. In this study, we distinguish the relative performance of two widely used nonlinear approximating networks, namely Artificial Neural Networks and Radial Basis Functions, and we further compare them with SDP. Besides, we comparatively assess state-of-the-art multi-objective evolutionary algorithms (MOEAs) in terms of efficiency, effectiveness, reliability, and controllability. Our diagnostic results show that RBFs solutions are more effective that ANNs in designing Pareto approximate policies for several water reservoir systems. They also highlight that EMODPS is very challenging for modern MOEAs and that epsilon dominance is critical for attaining high levels of performance. Epsilon dominance algorithms epsilon-MOEA, epsilon-NSGAII and the auto adaptive Borg MOEA, are statistically superior for the class of problems considered.

  12. Bridging to Heart Transplantation from the Biventricular Pulsatile Berlin Heart EXCOR Assist Device Support in a Patient with Advanced End-Organ Failure

    Directory of Open Access Journals (Sweden)

    Zumrut Tuba Demirozu

    2016-03-01

    Full Text Available Long-term mechanical circulatory support is a life-saving technology while briding to heart transplantation. It increases the quality of life and preserves end-organ function for patients with  advanced heart failure. The number of patients with advanced heart failure scheduled for heart transplantation before comorbidities escalate is on the rise. However, the device function is complicated by the bleeding-thrombosis and infection paradigm, hence the interest in understanding device thrombosis and infection. We describe a 27-year-old man with idiopathic cardiomyopathy, advanced end-organ failure, and severe infection, who was bridged to heart transplantation after 8 months on the Berlin Heart EXCOR (Berlin Heart AG, Berlin, Germany biventricular support. The patient was discharged from the hospital in the third postoperative week after the recovery of his end-organ functions. At 29 months’ post-transplantation follow-up, his last cardiac biopsy was grade 0, his ejection fraction was 60%, and he was enjoying a good quality of life.

  13. Bridging to Heart Transplantation from the Biventricular Pulsatile Berlin Heart EXCOR Assist Device Support in a Patient with Advanced End-Organ Failure

    Science.gov (United States)

    Tuba Demirozu, Zumrut; Suha Kucukaksu, Deniz

    2015-01-01

    Long-term mechanical circulatory support is a life-saving technology while briding to heart transplantation. It increases the quality of life and preserves end-organ function for patients with advanced heart failure. The number of patients with advanced heart failure scheduled for heart transplantation before comorbidities escalate is on the rise. However, the device function is complicated by the bleeding-thrombosis and infection paradigm, hence the interest in understanding device thrombosis and infection. We describe a 27-year-old man with idiopathic cardiomyopathy, advanced end-organ failure, and severe infection, who was bridged to heart transplantation after 8 months on the Berlin Heart EXCOR (Berlin Heart AG, Berlin, Germany) biventricular support. The patient was discharged from the hospital in the third postoperative week after the recovery of his end-organ functions. At 29 months’ post-transplantation follow-up, his last cardiac biopsy was grade 0, his ejection fraction was 60%, and he was enjoying a good quality of life. PMID:26985209

  14. Raising Expectations for U.S. Youth with Disabilities: Federal Disability Policy Advances Integrated Employment

    Directory of Open Access Journals (Sweden)

    Jeanne Novak

    2015-03-01

    Full Text Available While conversations around the inclusion of individuals with disabilities often focus on the educational rights and needs of children with disabilities during their school years, there is a growing recognition that the period of transition from secondary school to adult roles is a critical time in the lives of individuals with disabilities. For young people, gaining meaning ful employment in a typical community job is an important step towards realising full community membership. The present article examines how contemporary U.S. federal disability policy has heightened expectations that youth with disabilities – including those with significant disabilities – can and should be prepared to work in integrated workplaces. The article begins with a consideration of how evolving assumptions about the nature of disability and the employment potential of individuals with significant disabilities have influenced the development of federal disability policy in the U.S. This is followed by an overview of key legislative and policy developments in the areas of civil rights and workforce development that have the potential to dramatically impact the employment outlook for young people with disabilities. The article concludes with a discussion of challenges in translating the legislative intent of federal disability policy into noticeable improvements in employment outcomes, along with recommendations for aligning legislation, funding priorities and service delivery systems to achieve policy goals.

  15. Cost-Benefit Analysis of Confidentiality Policies for Advanced Knowledge Management Systems

    Energy Technology Data Exchange (ETDEWEB)

    May, D

    2003-03-01

    Knowledge Discovery (KD) processes can create new information within a Knowledge Management (KM) system. In many domains, including government, this new information must be secured against unauthorized disclosure. Applying an appropriate confidentiality policy achieves this. However, it is not evident which confidentiality policy to apply, especially when the goals of sharing and disseminating knowledge have to be balanced with the requirements to secure knowledge. This work proposes to solve this problem by developing a cost-benefit analysis technique for examining the tradeoffs between securing and sharing discovered knowledge.

  16. Advancing Health Marketing Research and Policy Recommendations by Incorporating Source Perspectives.

    Science.gov (United States)

    Mackert, Michael; Guadagno, Marie; Champlin, Sara

    2015-01-01

    Communication researchers, recognizing the message sent is not necessarily the same as the message received, have incorporated the perspective of advertising professionals into the study of advertising effects. Health marketing research could similarly benefit from incorporating this largely absent perspective into the academic and policy debate surrounding the impact of advertising on health issues ranging from obesity to alcohol use. This commentary serves as a call to action to stakeholders in this academic and policy debate: focus on the perspective of advertising professionals to enrich health marketing and public health research in which advertising is the delivery vehicle for health messages.

  17. Global Economic Effects of USA Biofuel Policy and the Potential Contribution from Advanced Biofuels

    Energy Technology Data Exchange (ETDEWEB)

    Gbadebo Oladosu; Keith Kline; Paul Leiby; Rocio Uria-Martinez; Maggie Davis; Mark Downing; Laurence Eaton

    2012-01-01

    This study evaluates the global economic effects of the USA renewable fuel standards (RFS2), and the potential contribution from advanced biofuels. Our simulation results imply that these mandates lead to an increase of 0.21 percent in the global gross domestic product (GDP) in 2022, including an increase of 0.8 percent in the USA and 0.02 percent in the rest of the world (ROW); relative to our baseline, no-RFS scenario. The incremental contributions to GDP from advanced biofuels in 2022 are estimated at 0.41 percent and 0.04 percent in the USA and ROW, respectively. Although production costs of advanced biofuels are higher than for conventional biofuels in our model, their economic benefits result from reductions in oil use, and their smaller impacts on food markets compared with conventional biofuels. Thus, the USA advanced biofuels targets are expected to have positive economic benefits.

  18. The Adoption of Advanced Fuel Cycle Technology Under a Single Repository Policy

    Energy Technology Data Exchange (ETDEWEB)

    Paul Wilson

    2009-11-02

    Develops the tools to investiage the hypothesis that the savings in repository space associated with the implementation of advanced nuclear fuel cycles can result in sufficient cost savings to offset the higher costs of those fuel cycles.

  19. Accuracy of Seattle Heart Failure Model and HeartMate II Risk Score in Non-Inotrope-Dependent Advanced Heart Failure Patients: Insights From the ROADMAP Study (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients).

    Science.gov (United States)

    Lanfear, David E; Levy, Wayne C; Stehlik, Josef; Estep, Jerry D; Rogers, Joseph G; Shah, Keyur B; Boyle, Andrew J; Chuang, Joyce; Farrar, David J; Starling, Randall C

    2017-05-01

    Timing of left ventricular assist device (LVAD) implantation in advanced heart failure patients not on inotropes is unclear. Relevant prediction models exist (SHFM [Seattle Heart Failure Model] and HMRS [HeartMate II Risk Score]), but use in this group is not established. ROADMAP (Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients) is a prospective, multicenter, nonrandomized study of 200 advanced heart failure patients not on inotropes who met indications for LVAD implantation, comparing the effectiveness of HeartMate II support versus optimal medical management. We compared SHFM-predicted versus observed survival (overall survival and LVAD-free survival) in the optimal medical management arm (n=103) and HMRS-predicted versus observed survival in all LVAD patients (n=111) using Cox modeling, receiver-operator characteristic (ROC) curves, and calibration plots. In the optimal medical management cohort, the SHFM was a significant predictor of survival (hazard ratio=2.98; Prisk subgroups. In non-inotrope-dependent advanced heart failure patients receiving optimal medical management, the SHFM was predictive of overall survival but underestimated the risk of clinical worsening and LVAD implantation. Among LVAD patients, the HMRS had marginal discrimination and underestimated survival post-LVAD implantation. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01452802. © 2017 American Heart Association, Inc.

  20. The preserved autonomic functions may provide the asymptomatic clinical status in heart failure despite advanced left ventricular systolic dysfunction.

    Science.gov (United States)

    Kocaman, Sinan Altan; Taçoy, Gülten; Ozdemir, Murat; Açıkgöz, Sadık Kadri; Cengel, Atiye

    2010-12-01

    Autonomic dysfunction is an important marker of prognosis in congestive heart failure (CHF) and may determine the symptoms and progression of CHF. The aim of our study was to investigate whether preserved autonomic function assessed by heart rate variability (HRV) analyses is related to absence of CHF symptoms despite prominently reduced systolic function. The study had a cross-sectional observational design. Fifty patients with left ventricular ejection fraction (EF) below 40% were enrolled. The patients were divided into two groups according to their CHF symptomatic status as Group 1 (NYHA functional class I, asymptomatic group) and Group 2 (NYHA functional class ≥ II, symptomatic group). Plasma C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-proBNP) levels, echocardiographic parameters and HRV indices were measured while the patients were clinically stable in each group. Possible factors associated with the development of CHF symptoms were assessed by using multiple regression analysis. Baseline clinical characteristics and left ventricular EF were similar in the two groups. Serum CRP (15 ± 21 vs 7 ± 18 mg/L, p=0.011) and NT-proBNP levels (1935 ± 1088 vs 1249 ± 1083 pg/mL, p=0.020) were significantly higher in symptomatic group. The HRV parameters (SDNN: 78 ± 57 vs 122 ± 42 ms, p=0.001; SDANN: 65 ± 55 vs 84 ± 38 ms, p=0.024; SDNNi: 36 ± 41 vs 70 ± 46 ms, p<0.001; triangular index [Ti]: 17 ± 12 vs 32 ± 14, p<0.001) were also significantly depressed in symptomatic group. When multiple regression analysis was performed, only HRV indices of autonomic function were significantly associated with the asymptomatic status (SDNN, OR: 1.016, 95%CI: 1.002-1.031, p=0.028; SDNNi, OR: 1.030, 95%CI: 1.008-1.052, p=0.006; TI, OR: 1.088, 95%CI: 1.019-1.161, p=0.011). Preserved autonomic functions were shown to be associated with absence of CHF symptoms independently of angiotensin converting enzyme inhibitor/angiotensin receptor blocker

  1. Advancing the field of elder abuse: future directions and policy implications.

    Science.gov (United States)

    Dong, XinQi

    2012-11-01

    Elder abuse, sometimes called elder mistreatment or elder maltreatment, includes psychological, physical, and sexual abuse; neglect (caregiver neglect and self-neglect); and financial exploitation. Evidence suggests that one in 10 older adults experiences some form of elder abuse, but only one in 25 cases is reported to social services agencies. At the same time, elder abuse is associated with significant morbidity and premature mortality. Despite these findings, there is a great paucity in research, practice, and policy addressing the pervasive issues of elder abuse. Through my experiences as a American Political Sciences Association Congressional Policy Fellow and Health and Aging Policy Fellow working with the Administration on Community Living (ACL) (previously known as the Administration on Aging) for the last 2 years, I will describe the major functions of the ACL and highlight two major pieces of federal legislation: The Older Americans Act and the Elder Justice Act. I will also highlight major research gaps and future policy relevant research directions for the field of elder abuse. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  2. Reframing Educational Policy: Democracy, Community, and the Individual. Advances in Contemporary Educational Thought, Volume 16.

    Science.gov (United States)

    Kahne, Joseph

    Rather than defining and debating particular goals, educational policymakers tend to focus on the technical issues surrounding educational practice. This book considers the social and ethical orientations that structure mainstream policy dialogues and the way in which adoption of some alternative social and ethical principles would change the form…

  3. Advancing Democratic Principles: A European Examines a Neglected American Asset. Ethics and Public Policy Essay 49.

    Science.gov (United States)

    Haseler, Stephen

    According to this essay by a visiting scholar from Great Britain, there will always be a debate in democratic societies, about the proper role of morality in fashioning and articulating foreign policy. This ambivalence has been reflected in the uneven approach to the problem exhibited by successive United States administrations. There are two…

  4. Advancing science and policy through a coordinated international study of physical activity and built environments

    DEFF Research Database (Denmark)

    Kerr, Jacqueline; Sallis, James F; Owen, Neville

    2013-01-01

    National and international strategies to increase physical activity emphasize environmental and policy changes that can have widespread and long-lasting impact. Evidence from multiple countries using comparable methods is required to strengthen the evidence base for such initiatives. Because some...

  5. A Continuous Review Inventory Model with Advance Policy Change and Obsolescence

    NARCIS (Netherlands)

    C. Pinçe (Çerağ); R. Dekker (Rommert)

    2010-01-01

    textabstractIn this paper, we consider a continuous review inventory system of a slow moving item for which the demand rate drops to a lower level at a pre-determined time. Inventory system is controlled according to one-for-one replenishment policy with fixed lead time. Adaptation to the lower

  6. Investigating reservation policies of advance orders in the presence of heterogeneous demand

    DEFF Research Database (Denmark)

    Du, Bisheng; Larsen, Christian

    , it may be sensible to make reservations for the order in the inventory system, thereby preventing later arriving orders from getting access to the inventory before this particular order. We propose various reservation policies and study their impact on the performance of the inventory system....

  7. Comparative social policy and political conflict in advanced welfare states: Denmark and Sweden.

    Science.gov (United States)

    Esping-Andersen, G

    1979-01-01

    There has developed an abundant literature on the social and political determinants of social policies, but few have addressed the question of how state policies, once implemented, affect the system of stratification in civil society. This article examines the political consequences of social policy in Denmark and Sweden, countries in which a social democratic labor movement has predominated for decades. Superficially, these two highly developed welfare states appear very similar. Yet the political and social contexts in which their social policies have evolved differ substantially. I shall demonstrate the argument that the traditional welfare state approach may be conducive to a new and powerful political conflict, which directly questions the legitimacy of the welfare state itself, unless government is successful in subordinating private capitalist growth to effective public regulation. In Denmark, where social democratic governments have failed to match welfare state growth with more control of private capital, social policy has tended to undermine the political unity of the working class. Consequently, the Social Democratic Party has been weakened. Social welfare programs, in effect, have helped create new forms of stratification within the working class. In Sweden, social democratic governments have been quite successful in shifting a decisive degree of power over the private market to the state. This has helped avert a crisis of the welfare state, and has also been an important condition for continued social democratic hegemony and working-class unity. I conclude that social reform politics tend to be problematic from the point of view of the future power of social democratic movements.

  8. Why Do Electricity Policy and Competitive Markets Fail to Use Advanced PV Systems to Improve Distribution Power Quality?

    Directory of Open Access Journals (Sweden)

    Mark P. McHenry

    2016-01-01

    Full Text Available The increasing pressure for network operators to meet distribution network power quality standards with increasing peak loads, renewable energy targets, and advances in automated distributed power electronics and communications is forcing policy-makers to understand new means to distribute costs and benefits within electricity markets. Discussions surrounding how distributed generation (DG exhibits active voltage regulation and power factor/reactive power control and other power quality capabilities are complicated by uncertainties of baseline local distribution network power quality and to whom and how costs and benefits of improved electricity infrastructure will be allocated. DG providing ancillary services that dynamically respond to the network characteristics could lead to major network improvements. With proper market structures renewable energy systems could greatly improve power quality on distribution systems with nearly no additional cost to the grid operators. Renewable DG does have variability challenges, though this issue can be overcome with energy storage, forecasting, and advanced inverter functionality. This paper presents real data from a large-scale grid-connected PV array with large-scale storage and explores effective mitigation measures for PV system variability. We discuss useful inverter technical knowledge for policy-makers to mitigate ongoing inflation of electricity network tariff components by new DG interconnection requirements or electricity markets which value power quality and control.

  9. Advanced policy options to regulate sugar-sweetened beverages to support public health.

    Science.gov (United States)

    Pomeranz, Jennifer L

    2012-02-01

    Consumption of sugar-sweetened beverages (SSBs) has increased worldwide. As public health studies expose the detrimental impact of SSBs, consumer protection and public health advocates have called for increased government control. A major focus has been on restricting marketing of SSBs to children, but many innovative policy options--legally defensible ways to regulate SSBs and support public health--are largely unexplored. We describe the public health, economic, and retail marketing research related to SSBs (including energy drinks). We review policy options available to governments, including mandatory factual disclosures, earmarked taxation, and regulating sales, including placement within retail and food service establishments, and schools. Our review describes recent international initiatives and classifies options available in the United States by jurisdiction (federal, state, and local) based on legal viability.

  10. Advancing methodological thinking and practice for development-compatible climate policy planning

    DEFF Research Database (Denmark)

    Scrieciu, S. Şerban; Belton, Valerie; Chalabi, Zaid

    2014-01-01

    body of competitive general equilibrium optimization models and cost-benefit analysis techniques of aggregation and monetization. However, its recommendations for climate action are often based on highly restrictive underlying assumptions, which have been increasingly criticized for being too......There are growing calls for identifying climate mitigation and adaptation policy packages that would also support human development objectives at the national and regional levels. The literature on climate policy analysis and impact assessment continues to be driven by standard economics with its......-adaptationdevelopment interactions, accounting for institutional barriers, and drawing on a combination of an emerging body of new climate economics and multi-criteria decision analysis is suggested. We purport that, by using this framework, multi-dimensional impacts and multistakeholder interests could be better represented when...

  11. RENEWABLE ENERGY, A KEY TO INTEGRATING COMPETITIVE POLICIES WITH ADVANCED ENVIRONMENT PROTECTION STRATEGIES

    OpenAIRE

    Cinade Lucian Ovidiu

    2011-01-01

    Development of competitive policies and improvement of environment protection strategies are two basic trends of the development of the European Unique Market. Energy, also known as "industry bread", is basic product and strategic resource, where energy industry plays an obvious role in the economic and social development of any community. Traditional energy production is marred by three major drawbacks: it generates negative externalities by polluting; it is totally in the hands of the produ...

  12. Malta’s Tourism Policy: Standing Still or Advancing towards Sustainability?

    OpenAIRE

    Rachel Dodds

    2007-01-01

    As with most warm water islands, Malta’s tourism has been historically focused towards sun, sea and sand package holidays. As a result, the ratio of visitors to locals has expanded very quickly and the strain on infrastructure from too many tourists is evident. As do other small islands, Malta also suffers from an absence of pluralism amongst the political-economic elite and a familiarity between voters and politicians, thereby creating barriers to implementing successful policies. Through an...

  13. Policies for accelerating access to clean energy, improving health, advancing development, and mitigating climate change.

    Science.gov (United States)

    Haines, Andy; Smith, Kirk R; Anderson, Dennis; Epstein, Paul R; McMichael, Anthony J; Roberts, Ian; Wilkinson, Paul; Woodcock, James; Woods, Jeremy

    2007-10-06

    The absence of reliable access to clean energy and the services it provides imposes a large disease burden on low-income populations and impedes prospects for development. Furthermore, current patterns of fossil-fuel use cause substantial ill-health from air pollution and occupational hazards. Impending climate change, mainly driven by energy use, now also threatens health. Policies to promote access to non-polluting and sustainable sources of energy have great potential both to improve public health and to mitigate (prevent) climate disruption. There are several technological options, policy levers, and economic instruments for sectors such as power generation, transport, agriculture, and the built environment. However, barriers to change include vested interests, political inertia, inability to take meaningful action, profound global inequalities, weak technology-transfer mechanisms, and knowledge gaps that must be addressed to transform global markets. The need for policies that prevent dangerous anthropogenic interference with the climate while addressing the energy needs of disadvantaged people is a central challenge of the current era. A comprehensive programme for clean energy should optimise mitigation and, simultaneously, adaption to climate change while maximising co-benefits for health--eg, through improved air, water, and food quality. Intersectoral research and concerted action, both nationally and internationally, will be required.

  14. Advancing One Health Policy and Implementation Through the Concept of One Medicine One Science.

    Science.gov (United States)

    Cardona, Carol; Travis, Dominic A; Berger, Kavita; Coat, Gwenaële; Kennedy, Shaun; Steer, Clifford J; Murtaugh, Michael P; Sriramarao, P

    2015-09-01

    Numerous interspecies disease transmission events, Ebola virus being a recent and cogent example, highlight the complex interactions between human, animal, and environmental health and the importance of addressing medicine and health in a comprehensive scientific manner. The diversity of information gained from the natural, social, behavioral, and systems sciences is critical to developing and sustainably promoting integrated health approaches that can be implemented at the local, national, and international levels to meet grand challenges. The Concept of One Medicine One Science (COMOS) as outlined herein describes the interplay between scientific knowledge that underpins health and medicine and efforts toward stabilizing local systems using 2 linked case studies: the food system and emerging infectious disease. Forums such as the International Conference of One Medicine One Science (iCOMOS), where science and policy can be debated together, missing pieces identified, and science-based collaborations formed among industry, governmental, and nongovernmental policy makers and funders, is an essential step in addressing global health. The expertise of multiple disciplines and research foci to support policy development is critical to the implementation of one health and the successful achievement of global health security goals.

  15. Advances in geospatial analysis platforms and tools: Creating space for differentiated policy and investment responses

    CSIR Research Space (South Africa)

    Maritz, Johan

    2010-09-01

    Full Text Available Over the last 5 years a set of incremental advances within geospatial analysis platforms and tools developed by the CSIR's Planning Support Systems in collaboration with key stakeholders such as The Presidency, enabled a more nuanced regional level...

  16. Limited advances in therapy of glioblastoma trigger re-consideration of research policy.

    Science.gov (United States)

    Frosina, Guido

    2015-11-01

    Glioblastoma (GB - WHO grade IV) is the most frequent and lethal primary brain tumour with median overall survival of 7-15 months after diagnosis. As in other cancer research areas, an overwhelming amount of pre-clinical research acquisitions in the GB field have not been translated to patients' benefit, potentially due to inappropriate treatment schedules and/or trial designs in the clinical setting. The recent failure of promising anti-VEGF bevacizumab to improve GB patients' overall survival recapitulates this sense of frustration. The following measures are proposed.

  17. Long-term survival results of a randomized phase III trial of vinflunine plus best supportive care versus best supportive care alone in advanced urothelial carcinoma patients after failure of platinum-based chemotherapy

    DEFF Research Database (Denmark)

    Bellmunt, J; Fougeray, R; Rosenberg, J E

    2013-01-01

    To compare long-term, updated overall survival (OS) of patients with advanced transitional cell carcinoma of the urothelium (TCCU) treated with vinflunine plus best supportive care (BSC) or BSC alone, after failure of platinum-based chemotherapy....

  18. Optimization of two-stage production/inventory systems under order base stock policy with advance demand information

    Science.gov (United States)

    Nakade, Koichi; Yokozawa, Shiori

    2016-08-01

    It is important to share demand information among the members in supply chains. In recent years, production and inventory systems with advance demand information (ADI) have been discussed, where advance demand information means the information of demand which the decision maker obtains before the corresponding actual demand arrives. Appropriate production and inventory control using demand information leads to the decrease of inventory and backlog costs. For a single stage system, the optimal base stock and release lead time have been discussed in the literature. In practical production systems the manufacturing system has multiple processes. The multiple stage production and inventory system with ADI, however, has been analyzed by simulation or assuming exponential processing time. That is, their theoretical analysis and optimization of release lead time and base stock level have little been obtained because of its difficulty. In this paper, theoretical analysis of a two-stage production inventory system with advance demand information is developed, where the processing time is assumed deterministic and identical; demand arrival process is Poisson, and an order base stock policy is adopted. Using the analytical results, optimal release lead time and optimal base stock levels for minimizing the average cost on the holding and backlog costs are explicitly derived.

  19. Effects of Fusion Zone Size and Failure Mode on Peak Load and Energy Absorption of Advanced High Strength Steel Spot Welds

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Xin; Stephens, Elizabeth V.; Khaleel, Mohammad A.

    2007-01-01

    This paper examines the effects of fusion zone size on failure modes, static strength and energy absorption of resistance spot welds (RSW) of advanced high strength steels (AHSS). DP800 and TRIP800 spot welds are considered. The main failure modes for spot welds are nugget pullout and interfacial fracture. Partial interfacial fracture is also observed. The critical fusion zone sizes to ensure nugget pull-out failure mode are developed for both DP800 and TRIP800 using limit load based analytical model and micro-hardness measurements of the weld cross sections. Static weld strength tests using cross tension samples were performed on the joint populations with controlled fusion zone sizes. The resulted peak load and energy absorption levels associated with each failure mode were studied for all the weld populations using statistical data analysis tools. The results in this study show that AHSS spot welds with fusion zone size of can not produce nugget pullout mode for both the DP800 and TRIP800 materials examined. The critical fusion zone size for nugget pullout shall be derived for individual materials based on different base metal properties as well as different heat affected zone (HAZ) and weld properties resulted from different welding parameters.

  20. Effects of Fusion Zone Size on Failure Modes and Performance of Advanced High Strength Steel Spot Welds (2006-01-0531)

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Xin; Stephens, Elizabeth V.; Khaleel, Mohammad A.

    2007-03-01

    This paper examines the effects of fusion zone size on failure modes, static strength and energy absorption of resistance spot welds (RSW) of advanced high strength steels (AHSS). DP800 and TRIP800 spot welds are considered. The main failure modes for spot welds are nugget pullout and interfacial fracture. Partial interfacial fracture is also observed. The critical fusion zone sizes to ensure nugget pull-out failure mode are developed for both DP800 and TRIP800 using the limit load based analytical model and the micro-hardness measurements of the weld cross sections. Static weld strength tests using cross tension samples were performed on the joint populations with controlled fusion zone sizes. The resulted peak load and energy absorption levels associated with each failure mode were studied using statistical data analysis tools. The results in this study show that the conventional weld size of 4 t1/2 can not produce nugget pullout mode for both the DP800 and TRIP800 materials. The results also suggest that performance based spot weld acceptance criteria should be developed for different AHSS spot welds.

  1. THE EAP: A FAILURE OF THE EUROPEAN NEIGHBOURHOOD POLICY OR SHARING A POWER BALANCE IN THE NEIGHBOURHOOD?

    Directory of Open Access Journals (Sweden)

    Nona TATIASHVILI

    2016-10-01

    Full Text Available The present paper analyses achievements and challenges of the EaP in the prism of EU-Russia asymmetric energy interdependence, as the major factor affecting the successful implementation of the Eastern partnership. To identify whether energy interdependence is the main sphere of interest in the EaP neighbourhood, where EU-Russia common interests intersect in one point or is it a sharing a power balance in “common neighbourhood”?. The research paper reviews major policy documents of the ENP/EaP, in order to analyze to what extent is policy coherent/incoherent towards partner countries. Moreover, the paper evaluates the European neighbourhood external policy instruments (the ENP/EaP from the perspective of three prioritised countries of the Eastern partnership: Moldova, Georgia and Ukraine, including the analysis of the effectiveness of proposed incentives under the ENP/EaP, as sufficient instruments for successful implementation of the Eastern partnership, in the presence of unpredictable external veto player.

  2. Scientific thinking in young children: theoretical advances, empirical research, and policy implications.

    Science.gov (United States)

    Gopnik, Alison

    2012-09-28

    New theoretical ideas and empirical research show that very young children's learning and thinking are strikingly similar to much learning and thinking in science. Preschoolers test hypotheses against data and make causal inferences; they learn from statistics and informal experimentation, and from watching and listening to others. The mathematical framework of probabilistic models and Bayesian inference can describe this learning in precise ways. These discoveries have implications for early childhood education and policy. In particular, they suggest both that early childhood experience is extremely important and that the trend toward more structured and academic early childhood programs is misguided.

  3. Screening for heart transplantation and left ventricular assist system: results from the ScrEEning for advanced Heart Failure treatment (SEE-HF) study.

    Science.gov (United States)

    Lund, Lars H; Trochu, Jean-Noel; Meyns, Bart; Caliskan, Kadir; Shaw, Steven; Schmitto, Jan D; Schibilsky, David; Damme, Laura; Heatley, Jerry; Gustafsson, Finn

    2017-09-27

    Heart transplantation (HTx) and implantable left ventricular assist systems (LVAS) improve outcomes in advanced heart failure but may be underutilized. We hypothesized that screening can identify appropriate candidates. The ScrEEning for advanced Heart Failure treatment (SEE-HF) study was a multicentre prospective study screening patients with existing cardiac resynchronization therapy (CRT) and/or implantable cardioverter-defibrillator (ICD) for ejection fraction ≤40% and New York Heart Association (NYHA) class III-IV, and subsequently for guideline-based HTx and LVAS indication. Of 1722 (mean age 64 ± 14 years, 26% women) patients screened at eight centres in seven European countries, 121 (7.0%) were eligible and 99 (5.7%; mean age 61 ± 10 years, 19% women) patients were enrolled for detailed assessment. Twenty-six of the 99 enrolled patients (26%) were eligible for either HTx or LVAD (18 eligible for HTx; 7 eligible for LVAD; and 1 eligible for both). Eleven patients were listed for HTx and three received an LVAS. Eligible patients were 61 ± 8 years and 19% women, whereas those actually receiving intervention were 56 ± 8 years and 8% women. Among patients with CRT and/or ICD, a minority have NYHA class III-IV heart failure and ejection fraction ≤40%. Among these, however, more than one-quarter have an unrecognized need for HTx or LVAS. When patients are offered intervention based on screening, many decline. Discrepancies exist between clinical and patient equipoise. Clinical Trial Registration ClinicalTrials.gov Unique Identifier: NCT00894387. © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology.

  4. Analysis of an M/G/1 Queue with Multiple Vacations, N-policy, Unreliable Service Station and Repair Facility Failures

    Directory of Open Access Journals (Sweden)

    Wenqing Wu

    2014-05-01

    Full Text Available This paper studies an M/G/1 repairable queueing system with multiple vacations and N-policy, in which the service station is subject to occasional random breakdowns. When the service station breaks down, it is repaired by a repair facility. Moreover, the repair facility may fail during the repair period of the service station. The failed repair facility resumes repair after completion of its replacement. Under these assumptions, applying a simple method, the probability that the service station is broken, the rate of occurrence of breakdowns of the service station, the probability that the repair facility is being replaced and the rate of occurrence of failures of the repair facility along with other performance measures are obtained. Following the construction of the long-run expected cost function per unit time, the direct search method is implemented for determining the optimum threshold N* that minimises the cost function.

  5. Impact of Baseline Systolic Blood Pressure and Long-Term Outcomes in Patients with Advanced Chronic Systolic Heart Failure (Insights from the BEST Trial)

    OpenAIRE

    2010-01-01

    The impact of baseline systolic blood pressure (SBP) on outcomes in advanced chronic systolic heart failure (HF) patients has not been studied using propensity-matched design. Of the 2706 Beta-Blocker Evaluation of Survival Trial (BEST) participants with chronic HF, New York Heart Association class III–IV symptoms and left ventricular ejection fraction ≤35%, 1751 had SBP ≤120 (median, 108; range, 70–120) mm Hg and 955 had SBP >120 (median, 134; range 121–192) mm Hg. Propensity scores for SBP ...

  6. 利尿剂在心力衰竭中的治疗进展%Research Advances in Diuretic Therapy for Heart Failure

    Institute of Scientific and Technical Information of China (English)

    宋菲(综述); 张冬颖; 刘剑(审校)

    2015-01-01

    心力衰竭(心衰)指心脏结构或功能性疾病导致心室充盈及(或)射血能力受损而引起的一组综合征。利尿剂在心力衰竭治疗中占重要地位,是治疗急性呼吸困难和维持慢性心衰血容量稳定的一线用药。合理使用利尿剂是其他治疗心衰药物取得成功的关键因素之一。利尿剂种类较多,近年有关利尿剂治疗心衰的研究不断涌现,尤其是托拉塞米、醛固酮受体拮抗剂、托伐普坦等在心衰治疗中的应用有较多的文献报道,该文就相关研究进展予以综述。%Heart failure refers to a series of clinical syndromes of impaired ability of the ventricle to fill or eject blood results from abnormality of cardiac structure or functional diseaseshe.Diuretics play an importantrole in heart failure therapy,they are the first-line drugs in treating acute dyspnea and maintaining thestability of blood volume in patients with chronic heart failure.The rational use of diuretics is one of the keyfactors that influence on the successfulness of other medicines in treating heart failure.In recent years,researcheson diuretics in treating heart failure are constantly emerging,especially on torasemide,aldosterone receptorantagonists,tolvaptan,etc.Here is to make a review of the advances in such researches .

  7. Effects of Fusion Zone Size and Failure Mode on Peak Load and Energy Absorption of Advanced High Strength Steel Spot Welds under Lap Shear Loading Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Xin; Stephens, Elizabeth V.; Khaleel, Mohammad A.

    2008-06-01

    This paper examines the effects of fusion zone size on failure modes, static strength and energy absorption of resistance spot welds (RSW) of advanced high strength steels (AHSS) under lap shear loading condition. DP800 and TRIP800 spot welds are considered. The main failure modes for spot welds are nugget pullout and interfacial fracture. Partial interfacial fracture is also observed. Static weld strength tests using lap shear samples were performed on the joint populations with various fusion zone sizes. The resulted peak load and energy absorption levels associated with each failure mode were studied for all the weld populations using statistical data analysis tools. The results in this study show that AHSS spot welds with conventionally required fusion zone size of can not produce nugget pullout mode for both the DP800 and TRIP800 welds under lap shear loading. Moreover, failure mode has strong influence on weld peak load and energy absorption for all the DP800 welds and the TRIP800 small welds: welds failed in pullout mode have statistically higher strength and energy absorption than those failed in interfacial fracture mode. For TRIP800 welds above the critical fusion zone level, the influence of weld failure modes on peak load and energy absorption diminishes. Scatter plots of peak load and energy absorption versus weld fusion zone size were then constructed, and the results indicate that fusion zone size is the most critical factor in weld quality in terms of peak load and energy absorption for both DP800 and TRIP800 spot welds.

  8. Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort.

    Science.gov (United States)

    Tan, Christina; Rubenson, David; Srivastava, Ajay; Mohan, Rajeev; Smith, Michael R; Billick, Kristen; Bardarian, Samuel; Thomas Heywood, J

    2017-07-03

    Left ventricular outflow tract velocity time integral (LVOT VTI) is a measure of cardiac systolic function and cardiac output. Heart failure patients with low cardiac output are known to have poor cardiovascular outcomes. Thus, extremely low LVOT VTI may predict heart failure patients at highest risk for mortality. Patients with heart failure and extremely low LVOT VTI were identified from a single-center database. Baseline characteristics and heart failure related clinical outcomes (death, LVAD) were obtained at 12 months. Correlation between clinical endpoints and the following variables were analyzed: ejection fraction (EF), pulmonary artery systolic pressure (PASP), NYHA class, renal function, Doppler cardiac output (CO), and LVOT VTI. Study cohort consisted of 100 patients. At the 12-month follow up period, 30 events (28 deaths, 2 LVADs) were identified. Occurrence of death and LVAD implantation was statistically associated with a lower LVOT VTI (p = 0.039) but not EF (p = 0.169) or CO (p = 0.217). In multivariate analysis, LVOT VTI (p = 0.003) remained statistically significant, other significant variables were age (p = 0.033) and PASP (p = 0.022). Survival analysis by LVOT VTI tertile demonstrated an unadjusted hazard ratio of 4.755 (CI 1.576-14.348, p = 0.006) for combined LVAD and mortality at one year. Extremely low LVOT VTI strongly predicts adverse outcomes and identifies patients who may benefit most from advanced heart failure therapies.

  9. Prevalence of AAV1 neutralizing antibodies and consequences for a clinical trial of gene transfer for advanced heart failure.

    Science.gov (United States)

    Greenberg, B; Butler, J; Felker, G M; Ponikowski, P; Voors, A A; Pogoda, J M; Provost, R; Guerrero, J; Hajjar, R J; Zsebo, K M

    2016-03-01

    Adeno-associated virus serotype 1 (AAV1) has many advantages as a gene therapy vector, but the presence of pre-existing neutralizing antibodies (NAbs) is an important limitation. This study was designed to determine: (1) characteristics of AAV NAbs in human subjects, (2) prevalence of AAV1 NAbs in heart failure patients and (3) utility of aggressive immunosuppressive therapy in reducing NAb seroconversion in an animal model. NAb titers were assessed in a cohort of heart failure patients and in patients screened for a clinical trial of gene therapy with AAV1 carrying the sarcoplasmic reticulum calcium ATPase gene (AAV1/SERCA2a). AAV1 NAbs were found in 59.5% of 1552 heart failure patients. NAb prevalence increased with age (P=0.001) and varied geographically. The pattern of NAb titers suggested that exposure is against AAV2, with AAV1 NAb seropositivity due to crossreactivity. The effects of immunosuppression on NAb formation were tested in mini-pigs treated with immunosuppressant therapy before, during and after a single AAV1/SERCA2a infusion. Aggressive immunosuppression did not prevent formation of AAV1 NAbs. We conclude that immunosuppression is unlikely to be a viable solution for repeat AAV1 dosing. Strategies to reduce NAbs in heart failure patients are needed to increase eligibility for gene transfer using AAV vectors.

  10. Air Force Policy for Advanced Education: Production of Human Capital or Cheap Signals?

    Science.gov (United States)

    2011-01-01

    many reasons to be discouraged or dissatis­ fied with our current system —limited PME in-residence slots, limited advanced degree opportunities, or...improve their ability to serve the Air Force—or both. To help dissect and answer this question about the role of AADs in our promotion systems , the...analyzed promotion data, a perusal of the list of off-duty education programs mar­ keted to military personnel, such as those offered by American

  11. Second-line docetaxel-based chemotherapy after failure of fluorouracil-based first-line treatment for advanced esophageal squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Song ZB

    2014-10-01

    Full Text Available Zhengbo Song, Yiping Zhang Department of Chemotherapy, Zhejiang Cancer Hospital, Hangzhou, People's Republic of China Purpose: This retrospective analysis evaluates the clinical efficacy and toxicity of second-line docetaxel-based chemotherapy after failure of fluorouracil-based first-line treatment for advanced esophageal squamous cell carcinoma (ESCC. Methods: We retrospectively reviewed patients who had received second-line docetaxel-based chemotherapy for advanced ESCC in Zhejiang Cancer Hospital between January 2008 and December 2011. Survival curves were plotted using the Kaplan–Meier method. The Cox proportional hazard model was used for multivariate analysis. Results: Eighty-five patients received docetaxel-based second-line chemotherapy after the failure of first-line fluorouracil-based treatment. Forty-four patients received docetaxel-platinum chemotherapy, and 41 received docetaxel single-agent treatment. The progression-free survival (PFS and overall survival (OS were 3.5 and 5.5 months in all of the patients, respectively. There were no statistically significant differences in PFS and OS between docetaxel-platinum and docetaxel single-agent chemotherapy groups (P-value 0.38 and 0.64, respectively. Response to first-line chemotherapy was a favorable prognostic factor for PFS in uni- and multivariate analyses (P-value 0.005 and 0.028, respectively. Conclusion: Patients with docetaxel-based second-line treatment obtained a moderate PFS advantage in advanced ESCC. Response to first-line chemotherapy was a favorable prognostic factor for PFS of second-line chemotherapy in advanced ESCC. Keywords: ESCC, efficacy, toxicity

  12. Providing Policy Implication Based on the R and D Portfolio Analysis in Advanced Countries in the Nuclear Technology

    Energy Technology Data Exchange (ETDEWEB)

    Moon, K. H.; Lee, M. K.; Won, B. C.; Kim, S. S.; Lee, J. H.; Yun, S. W.; Jeong, I. K.; Lee, Y. C.; Lee, Y. J.; Kim, Y. S.

    2013-08-15

    This study is to provide the investment direction of nuclear R and D, which is the most efficient and reasonable integrating the various aspects comprehensively. This study includes four parts. In the first part, we extracted Mega-trend and driving forces of nuclear R and D field by using various reports published by National Intelligence Council of US, UN, etc. Also, in this part we established the linkage between megatrend factors focussing on nuclear and the five aspects including society, technology, ecology, economics and politics. In the second part, we analyzed the nuclear R and D investment directions of major advanced countries including US, Japan, EU and China for comparing the investment portfolio in the specific research area. In the third part, domestic investment of nuclear R and D was reviewed by analyzing the investment trend of nuclear R and D in the past, with their connection to nuclear policy, and to the levels and capacities of national technologies of nuclear. In the final part, the desirable directions of nuclear R and D investment were suggested comprehensively taking into consideration various aspects including the Mega-trend associated with nuclear, nuclear R and D directions of major advanced countries, and the level and capacities of the domestic nuclear technologies.

  13. Advances of metabolic therapy for heart failure%心力衰竭的代谢治疗进展

    Institute of Scientific and Technical Information of China (English)

    黄震华

    2011-01-01

    The hyperadrenergic state of heart failure can cause the increase of plasma free fatty acid,insulin resistance and decrease of glucose oxidation, result in the decrease of energy production, increase of free radical generation and inflammatory markers, and thereby, make heart failure worse.Adrenergic beta receptor antagonists, trimetazidine, ranolazine, perhexiline and metformin were currently paid more attention in the study of metabolic therapy for heart failure.%心力衰竭时交感神经兴奋性增加,使血浆游离脂肪酸浓度增高,引起胰岛素抵抗、葡萄糖氧化减少、游离脂肪酸氧化增加,导致能量产生减少、氧自由基和炎症介质产生增加,均加剧心力衰竭.肾上腺素β受体拮抗药、曲美他嗪、雷诺嗪、哌克昔林、二甲双呱等是目前心力衰竭代谢治疗中研究最多的药物.

  14. The GMOS cyber(e)-infrastructure: advanced services for supporting science and policy.

    Science.gov (United States)

    Cinnirella, S; D'Amore, F; Bencardino, M; Sprovieri, F; Pirrone, N

    2014-03-01

    The need for coordinated, systematized and catalogued databases on mercury in the environment is of paramount importance as improved information can help the assessment of the effectiveness of measures established to phase out and ban mercury. Long-term monitoring sites have been established in a number of regions and countries for the measurement of mercury in ambient air and wet deposition. Long term measurements of mercury concentration in biota also produced a huge amount of information, but such initiatives are far from being within a global, systematic and interoperable approach. To address these weaknesses the on-going Global Mercury Observation System (GMOS) project ( www.gmos.eu ) established a coordinated global observation system for mercury as well it retrieved historical data ( www.gmos.eu/sdi ). To manage such large amount of information a technological infrastructure was planned. This high-performance back-end resource associated with sophisticated client applications enables data storage, computing services, telecommunications networks and all services necessary to support the activity. This paper reports the architecture definition of the GMOS Cyber(e)-Infrastructure and the services developed to support science and policy, including the United Nation Environmental Program. It finally describes new possibilities in data analysis and data management through client applications.

  15. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    2005186 The diagnostic application of bedside measurement of plasma brain natriuretic in patients with heart failure. SHAO Le-wen (邵乐文) , Advanced Ward Dept, 1st Hosp, Med Sch, Zhejiang Univ, Hangzhou 310003. Chin J Intern Med, 2005;44(2): 99-101. Objective: To investigate differential diagnosis value of ultra-rapid bedside measurement of brain na-triuretic peptide (BNP) in patients with dyspnea.

  16. RENEWABLE ENERGY, A KEY TO INTEGRATING COMPETITIVE POLICIES WITH ADVANCED ENVIRONMENT PROTECTION STRATEGIES

    Directory of Open Access Journals (Sweden)

    Cinade Lucian Ovidiu

    2011-12-01

    Full Text Available Development of competitive policies and improvement of environment protection strategies are two basic trends of the development of the European Unique Market. Energy, also known as 'industry bread', is basic product and strategic resource, where energy industry plays an obvious role in the economic and social development of any community. Traditional energy production is marred by three major drawbacks: it generates negative externalities by polluting; it is totally in the hands of the producers; hence, prices rise at their will, of fossil fuels such as oil and gas. Present study focuses on electric energy industry, yet bearing over the whole length of the chain producer-to-end-consumer, thus revealed as particularly complex. The question is do alternative energy sources meet the prerequisite of market being competitive meanwhile environment protection being highly observed. We identify limits in point, of the energy market; effects of market liberalization; entry barriers; interchangeability level of energy sources; active forces on the energy market. Competitive rivalry has been expressed as per market micro-economic analysis, based on Michael Porter's 5-forces model. It will thus be noticed that, morphologically, competition evolution depends firstly on the market type. For the time being, the consumer on the energy market stays captive, for various reasons such as: legislation; limits of energy transfer infrastructure; scarcity of resources; resources availability imbalance; no integrative strategy available, of renewable energy resources usage. Energy availability is vital for human society to function. Comparative advantages of renewable energy resources are twofold, as manifested: in terms of economics, i.e. improving competition by substitute products entered at the same time as new producers enter market; and in terms of ecology, by reducing CO2 emissions. As to energy production technology and transfer, the complementary nature will

  17. INDIGENOUS STUDENTS IN PUBLIC SCHOOLS IN URBAN RONDÔNIA: THE OMISSION OF PUBLIC POLICY FAILURE OF ETHNIC ORIGINS.

    Directory of Open Access Journals (Sweden)

    Vanubia Sampaio Santos

    2013-04-01

    Full Text Available This work presents the outline of a study that is underway, seeking evidence and question the reality of Indian students in schools not as the situations of indigenous affirmation and omission identity (ethnic belonging in urban public schools in Rondônia. The obtained data show everyday situations that characterize violence and prejudice against students indígenas.Essas and other situations that reveals the interethnic tension remains dormant and can manifest in many different situations. At school, occurs in intercultural interaction. To discuss these and other issues raised in the survey, support for authors who discuss indigenous education, management, public policy, anti-colonialist project, empowerment, autonomy and leadership indigenous perspective of the indigenous movement with Grupioni (2001, Lopes da Silva (2000; D'Angelis (2012; Bergamaschi (2012, Both (2009; Mendonça (2009; Castoriadis (1988; Secchi (2008; Tadeu da Silva (1999 and Paulo Freire (1982 with their outstanding contribution to the dialogue on indigenous education. Keywords: Indian student. Urban school. Prejudice. Omission identity.

  18. Influenza vaccination: from epidemiological aspects and advances in research to dissent and vaccination policies.

    Science.gov (United States)

    Gasparini, R; Amicizia, D; Lai, P L; Panatto, D

    2016-01-01

    Influenza is a serious public health problem, since seasonal epidemics affect approximately 5-10% of the population and thus give rise to a heavy social and healthcare burden. The heavy burden of disease is due to several factors, one of which is the biological features of the pathogen. Indeed influenza viruses display high mutation rates and undergo frequent genetic reassortment. Minor variations cause seasonal epidemics and major variations, which result from the hybridization of viruses typical of different animal species, can lead to pandemics. Vaccination remains the most efficacious means of mitigating the harmful healthcare and social effects of influenza. Influenza vaccines have evolved over time in order to offer broader protection against circulating strains. Trivalent vaccines containing two A viruses and one B virus are currently available. However, given the co-circulation of both B virus lineages (B/Yamagata and B/Victoria), quadrivalent vaccines have recently been developed. The new quadrivalent vaccines constitute a great advance, in that they can offer broader strain coverage. Despite the availability of effective and safe influenza vaccines, the Italian public's trust in vaccination has declined and, in the last few years, influenza vaccination coverage rates have decreased both among the elderly and among at-risk adults. It is therefore necessary that users, in their own interests, regain trust in this important means of disease prevention. In order to mitigate the damage wreaked by influenza, it seems important to: (i) improve clinical-epidemiological and virological surveillance of the disease; (ii) promote the development of new efficacious vaccines, as has recently been done through the introduction of the quadrivalent vaccine; (iii) extend free vaccination to the entire population, as in the US and Canada; (iv) ensure that general healthcare professionals are properly informed and always updated with regard to vaccination; (v) promote public

  19. A study to improve communication between clinicians and patients with advanced heart failure: methods and challenges behind the working to improve discussions about defibrillator management trial.

    Science.gov (United States)

    Goldstein, Nathan E; Kalman, Jill; Kutner, Jean S; Fromme, Erik K; Hutchinson, Mathew D; Lipman, Hannah I; Matlock, Daniel D; Swetz, Keith M; Lampert, Rachel; Herasme, Omarys; Morrison, R Sean

    2014-12-01

    We report the challenges of the Working to Improve Discussions About Defibrillator Management trial, our novel, multicenter trial aimed at improving communication between cardiology clinicians and their patients with advanced heart failure (HF) who have implantable cardioverter defibrillators (ICDs). The study objectives are (1) to increase ICD deactivation conversations, (2) to increase the number of ICDs deactivated, and (3) to improve psychological outcomes in bereaved caregivers. The unit of randomization is the hospital, the intervention is aimed at HF clinicians, and the patient and caregiver are the units of analysis. Three hospitals were randomized to usual care and three to intervention. The intervention consists of an interactive educational session, clinician reminders, and individualized feedback. We enroll patients with advanced HF and their caregivers, and then we regularly survey them to evaluate whether the intervention has improved communication between them and their HF providers. We encountered three implementation barriers. First, there were institutional review board concerns at two sites because of the palliative nature of the study. Second, we had difficulty in creating entry criteria that accurately identified an HF population at high risk of dying. Third, we had to adapt our entry criteria to the changing landscape of ventricular assist devices and cardiac transplant eligibility. Here we present our novel solutions to the difficulties we encountered. Our work has the ability to enhance conduct of future studies focusing on improving care for patients with advanced illness.

  20. Resection of Locally Advanced Pancreatic Neoplasms after Neoadjuvant Chemotherapy with Nab-Paclitaxel and Gemcitabine following FOLFIRINOX Failure

    Directory of Open Access Journals (Sweden)

    Sarah Hahn

    2017-08-01

    Full Text Available The incidence of pancreatic cancer has dramatically increased over the past years, but the prognosis has not improved. Between 30 and 40% of tumors are considered locally advanced, essentially due to vascular involvement. In recent years, new chemotherapy protocols with high response rates have been developed. FOLFIRINOX seems to be an interesting option in this situation, but hematologic toxicity could be an obstacle to its prescription. Nab-paclitaxel and gemcitabine offer significant response rates with a reasonable safety profile. We report here a single-center experience of 2 cases with a locally advanced pancreatic cancer initially considered unresectable, progressive after first-line neoadjuvant FOLFIRINOX chemotherapy, and then treated with second-line nab-paclitaxel/gemcitabine chemotherapy.

  1. Use of inotropic agents in patients with advanced heart failure: lessons from recent trials and hopes for new agents.

    Science.gov (United States)

    Metra, Marco; Bettari, Luca; Carubelli, Valentina; Bugatti, Silvia; Dei Cas, Alessandra; Del Magro, Francesca; Lazzarini, Valentina; Lombardi, Carlo; Dei Cas, Livio

    2011-03-26

    Abnormalities of cardiac function, with high intraventricular filling pressure and low cardiac output, play a central role in patients with heart failure. Agents with inotropic properties are potentially useful to correct these abnormalities. However, with the exception of digoxin, no inotropic agent has been associated with favourable effects on outcomes. This is likely related to the mechanism of action of current agents, which is based on an increase in intracellular cyclic adenosine monophosphate and calcium concentrations. Novel agents acting through different mechanisms, such as sarcoplasmic reticulum calcium uptake, cardiac myosin and myocardial metabolism, have the potential to improve myocardial efficiency and lower myocardial oxygen consumption. These characteristics might allow a haemodynamic improvement in the absence of untoward effects on the clinical course and prognosis of the patients.

  2. Patients' preferences and willingness-to-pay for postmenopausal hormone receptor-positive, HER2-negative advanced breast cancer treatments after failure of standard treatments.

    Science.gov (United States)

    Ngorsuraches, Surachat; Thongkeaw, Klangjai

    2015-01-01

    Patients' preferences increasingly play roles in cancer treatments. The objective of this study is to examine breast cancer patients' preferences and willingness-to-pay (WTP) for postmenopausal hormone receptor-positive, HER2-negative advanced breast cancer treatments after failure of standard treatments. Four attributes, i.e. progression free survival (PFS), anemia, pneumonitis, and cost, and their levels of exemestane and exemestane plus everolimus from literature and patient interviews were used to develop a discrete choice experiment questionnaire. Each questionnaire was composed of seven choice sets and each choice set contained those four attributes with different levels. Breast cancer patients were asked to choose one treatment alternative in each choice set. Multinomial logit model was used to determine relative preferences of each attribute and the WTP for all attributes and treatments were calculated. A total of 146 patients were included in study analyses. Results showed that the patients preferred treatments with higher PFS and lower side effects. The patients were willing to pay US$151.6, US$69.8, and US$278.3 per month in exchange for every 1 month increase in PFS and every 1 % decreased risk of anemia and pneumonitis, respectively. The patients were willing to pay for exemestane and exemestane plus everolimus US$551.8 and US$414.2 per month, respectively. In conclusion, patients weighted importance on PFS, anemia, and pneumonitis, when they needed to choose an aromatase inhibitor plus mammalian target of rapamycin (mTOR) inhibitor for advanced breast cancer treatments after failure of standard treatments. They valued exemestane alone more than exemestane plus everolimus.

  3. Challenges in personalised management of chronic diseases-heart failure as prominent example to advance the care process.

    Science.gov (United States)

    Brunner-La Rocca, Hans-Peter; Fleischhacker, Lutz; Golubnitschaja, Olga; Heemskerk, Frank; Helms, Thomas; Hoedemakers, Thom; Allianses, Sandra Huygen; Jaarsma, Tiny; Kinkorova, Judita; Ramaekers, Jan; Ruff, Peter; Schnur, Ivana; Vanoli, Emilio; Verdu, Jose; Zippel-Schultz, Bettina

    2015-01-01

    Chronic diseases are the leading causes of morbidity and mortality in Europe, accounting for more than 2/3 of all death causes and 75 % of the healthcare costs. Heart failure is one of the most prominent, prevalent and complex chronic conditions and is accompanied with multiple other chronic diseases. The current approach to care has important shortcomings with respect to diagnosis, treatment and care processes. A critical aspect of this situation is that interaction between stakeholders is limited and chronic diseases are usually addressed in isolation. Health care in Western countries requires an innovative approach to address chronic diseases to provide sustainability of care and to limit the excessive costs that may threaten the current systems. The increasing prevalence of chronic diseases combined with their enormous economic impact and the increasing shortage of healthcare providers are among the most critical threats. Attempts to solve these problems have failed, and future limitations in financial resources will result in much lower quality of care. Thus, changing the approach to care for chronic diseases is of utmost social importance.

  4. Evaluating Energy Efficiency Policies with Energy-Economy Models

    Energy Technology Data Exchange (ETDEWEB)

    Mundaca, Luis; Neij, Lena; Worrell, Ernst; McNeil, Michael A.

    2010-08-01

    The growing complexities of energy systems, environmental problems and technology markets are driving and testing most energy-economy models to their limits. To further advance bottom-up models from a multidisciplinary energy efficiency policy evaluation perspective, we review and critically analyse bottom-up energy-economy models and corresponding evaluation studies on energy efficiency policies to induce technological change. We use the household sector as a case study. Our analysis focuses on decision frameworks for technology choice, type of evaluation being carried out, treatment of market and behavioural failures, evaluated policy instruments, and key determinants used to mimic policy instruments. Although the review confirms criticism related to energy-economy models (e.g. unrealistic representation of decision-making by consumers when choosing technologies), they provide valuable guidance for policy evaluation related to energy efficiency. Different areas to further advance models remain open, particularly related to modelling issues, techno-economic and environmental aspects, behavioural determinants, and policy considerations.

  5. Percutaneous Hemodynamic Support (Impella) in Patients with Advanced Heart Failure and/or Cardiogenic Shock Not Eligible to PROTECT II Trial.

    Science.gov (United States)

    Liu, Wei; Mukku, Venkata Kishore; Gilani, Syed; Fujise, Ken; Barbagelata, Alejandro

    2013-12-01

    PROTECT I and II trials have tested the efficacy of Impella in patents with high-risk percutaneous coronary intervention (PCI). However, patients with severe hemodynamic instability such as cardiac arrest, ST-segment elevated myocardial infarction (STEMI), or cardiogenic shock were excluded. The objective was to investigate the efficacy of Impella in sicker patient population who were not included in PROTECT trials. These patients merit high-risk PCI who had cardiogenic shock and unstable or decompensated heart failure (HF). From December 2010 to March 2012, 10 consecutive patients with extremely high surgical risk and hemodynamic instability underwent urgent PCI with Impella 2.5 support (Abiomed Inc., Danvers, MA). These patients were presented with advance HF and/or cardiogenic shock. Among the 10 included patients, 3 patients were with cardiac arrest and 1 patient was with acute myocardial infarction. All patients had successful Impella implantation and remained hemodynamically stable during high-risk PCI. Among the 10 patients 2 patients (20%) died within 1 month and 1 patient developed limb ischemia. In high-risk population nonrandomizable to PROTECT trials with advance HF/cardiogenic shock, Impella could be an important tool for hemodynamic support to PCI or could be a bridge to left ventricle assist device to achieve good recovery. Larger studies need to be conducted on this high-risk population.

  6. Palliative radiotherapy in locally advanced head and neck cancer after failure of induction chemotherapy: Comparison of two fractionation schemes

    Directory of Open Access Journals (Sweden)

    Kailash Chandra Pandey

    2013-01-01

    Full Text Available Context: Among patients with locally advanced head and neck squamous cell cancers (LAHNSCC, the prognosis after nonresponse or progression despite induction chemotherapy (IC is dismal, and further treatment is often palliative in intent. Given that nonresponse to chemotherapy could indicate subsequent radioresistance, we intended to assess the outcomes with two different fractionation schemes. Aims: To compare the outcomes of two fractionation schemes- ′standard′ (consisting 3GyX5 daily fractions for 2 consecutive weeks versus ′hybrid′ (6GyX3 fractions on alternate days during the 1 st week, followed by 2GyX5 daily fractions in the 2 nd week. Settings and Design: Prospective randomized controlled two-arm unblinded trial. Materials and Methods: Patients with locally advanced oropharyngeal, laryngeal, and hypopharyngeal cancers treated with a minimum of two cycles of taxane, platinum, and fluorouracil-based IC were eligible if residual disease volume amounted >30 cm 3 . Kaplan-Meier survival curves were compared by the log-rank test. Response rates were compared using the unpaired t-test. Quality of life (QOL was measured via patient reported questionnaires. Results: Of the initially enrolled 51 patients, 45 patients (24 from standard arm, and 21 from the hybrid arm were eligible for analysis. Despite being underpowered to attain statistical significance, there still seemed to be a trend towards improvement in progression-free (Hazard ratio (HR for progression: 0.5966; 95% CI 0.3216-1.1066 and overall survival (HR for death: 0.6062; 95% CI 0.2676-1.3734 with the hybrid arm when compared to the standard arm. Benefits were also observed with regards to response rates and QOL. Rate of complications were similar in both arms. Conclusions: In comparison to the routinely used palliative fractionation scheme of 30 Gray (Gy in 10 fractions (Fr, the use of hybrid fractionation which integrates hypofractionation in the 1 st week, followed by

  7. Rationale and Design of a Randomized, Double-Blind, Placebo Controlled Multicenter Trial to Study Efficacy, Security, and Long Term Effects of Intermittent Repeated Levosimendan Administration in Patients with Advanced Heart Failure: LAICA study

    OpenAIRE

    García-González, Martín J.; de Mora-Martín, Manuel; López-Fernández, Silvia; López-Díaz, Javier; Martínez Sellés Oliveria Soares, Manuel; Romero-García, José; Cordero, Marco; Lara-Padrón, Antonio; Marrero-Rodríguez, Francisco; García-Saiz, María del Mar

    2013-01-01

    Background Advanced heart failure (HF) is associated with high morbidity and mortality; it represents a major burden for the health system. Episodes of acute decompensation requiring frequent and prolonged hospitalizations account for most HF-related expenditure. Inotropic drugs are frequently used during hospitalization, but rarely in out-patients. The LAICA clinical trial aims to evaluate the effectiveness and safety of monthly levosimendan infusion in patients with advanced HF to reduce th...

  8. Impact of health policy and practice on finding the best fit for patients with type 2 diabetes after metformin failure: Croatian pilot study.

    Science.gov (United States)

    Cigrovski Berković, Maja; Herman Mahečić, Davorka; Gradišer, Marina; Bilić-Ćurčić, Ines

    2017-06-01

    We assessed the impact of clinical practice and health policy on the choice and efficacy of different second-line therapies for the treatment of type 2 diabetes (T2DM) after failure of metformin. This retrospective database analysis included 200 patients with a follow-up period of 6 months. The primary end-point was achievement of HbA1c <7% and fasting (FBG) and postprandial glucose levels (PPG) <7.2mmol/L and <10mmol/L, respectively after three and six months of different add-on treatments. Secondary end-points were weight change during treatment and incidence of hypoglycemia. All second-line therapeutic options, except human basal insulin (BHI) and thiazolidendions (TZD) significantly increased the proportion of patients reaching target HbA1c after 6 months (p<0.01). Only sulfonylurea (SU) and dipeptidyl peptidase-4 (DPP-4) inhibitors significantly reduced all monitored parameters of glucoregulation without changing body weight and BMI after 3 and 6 months as opposed to insulin agents. However, there were no statistically significant differences between the groups when adjusting for starting HbA1c, FBG and PPG (F=1.16, p=NS), although a statistically significant difference in HbA1c levels (F=3.35, p<0.01) persisted in DPP-4 inhibitor users. The incidence of hypoglycemia was significantly higher in patients treated with NPH insulin and premixed insulin than in patients treated with other agents. A more aggressive approach is needed with early treatment intensification using available agents. Copyright © 2017 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  9. 先进高强度钢的断裂失效准则研究%STUDY OF FAILURE CRITERION OF ADVANCED HIGH STRENGTH STEEL

    Institute of Scientific and Technical Information of China (English)

    桂良进; 高付海; 范子杰

    2012-01-01

    The advanced high strength steel (AHSS) realizes the outstanding advantage of strength by transforming its internal different phases. It has become one of the hottest materials for current automotive lightweight researches. However, compared with traditional deep-drawing steels, the widespread use of AHSS in auto-industry is hampered due to its poor ductility,which leads to frequent occurrences of failure in the mode of fracture during the process of stamping. Therefore,the fracture prediction of AHSS becomes one of the focuses of current researchers. The dual phase (DP) steel can be seen as the representative of AHSS. In this paper,the fracture criteria of DP steel under different stress states are investigated by combining experimental and numerical analysis and an appropriate failure criterion is attempted to be established for predicting its fracture behavior.%先进高强度钢(AHSS)是通过相变获得高强度的应用前景最好的汽车轻量化材料.与传统深拉钢相比,AHSS韧性相对较低,在冲压成形过程中容易发生断裂,阻碍了它在汽车上的广泛应用,因而AHSS的断裂失效研究成为当前国内外研究的热点.论文以AHSS的代表钢种双相钢(DP)为研究对象,通过试验与数值计算相结合的方法研究其在不同三轴应力状态下的失效特性,尝试寻找一个适用于它的失效准则,用于其断裂失效的预测.

  10. Immediate challenge of combating climate change: Effective implementation of energy efficiency policies

    Energy Technology Data Exchange (ETDEWEB)

    Morvaj, Zoran; Bukarica, Vesna

    2010-09-15

    Energy efficiency is the most readily available, rapid and cost-effective way to achieve desired greenhouse gases reductions. Therefore, it is the focus of energy and climate change policies world wide. The results of these policies are still missing in the desired extent, even in the EU, which has the most advanced energy efficiency policy. The main reason behind this policy failure is a complete lack of focus on implementing capacities that would ensure full policy uptake. Embracing full-scale energy management systems in public and business sectors and mobilisation of and cooperation between all stakeholders are the way towards higher efficiency.

  11. Integrated environmental policy: A review of economic analysis.

    Science.gov (United States)

    Wiesmeth, Hans; Häckl, Dennis

    2017-04-01

    Holistic environmental policies, which emerged from a mere combination of technical activities in waste management some 40 years ago, constitute the most advanced level of environmental policies. These approaches to environmental policy, among them the policies in integrated waste management, attempt to guide economic agents to an environment-friendly behaviour. Nevertheless, current holistic policies in waste management, including policies on one-way drinks containers and waste electrical and electronic equipment, and implementations of extended producer responsibility with further applications to waste electrical and electronic equipment, reveal more or less severe deficiencies - despite some positive examples. This article relates these policy failures, which are not necessarily the result of an insufficient compliance with the regulations, to missing constitutive elements of what is going to be called an 'integrated environmental policy'. This article therefore investigates - mostly from a practical point of view - constitutive elements, which are necessary for a holistic policy to serve as a well-functioning allocation mechanism. As these constitutive elements result from a careful 'integration' of the environmental commodities into the economic allocation problems, we refer to these policies as 'integrated environmental policies'. The article also discusses and illustrates the main steps of designing such a policy - for waste electrical and electronic equipment and a (possible) ban of Glyphosat in agriculture. As these policies are dependent on economic and political stability with environmental awareness sufficiently developed, the article addresses mostly waste management policies in highly industrialised countries.

  12. Advance demand information and a restricted production capacity : On the optimality of order base-stock policies

    NARCIS (Netherlands)

    Wijngaard, Jacob; Karaesmen, Fikri

    2007-01-01

    This paper considers the optimality of order aggregation in a single-item production/inventory problem with advance demand information and a restricted production capacity. The advance demand information is modeled by introducing a positive customer order lead time. The paper proves, when customer o

  13. Emerging methods and tools for environmental risk assessment, decision-making, and policy for nanomaterials: summary of NATO Advanced Research Workshop

    DEFF Research Database (Denmark)

    Linkov, I; Steevens, J; Adlakha-Hutcheon, G

    2009-01-01

    Nanomaterials and their associated technologies hold promising opportunities for the development of new materials and applications in a wide variety of disciplines, including medicine, environmental remediation, waste treatment, and energy conservation. However, current information regarding...... implications. Four corresponding working groups (WGs) were formed to develop detailed summaries of the state-of-the-science in their respective areas and to discuss emerging gaps and research needs. The WGs identified gaps between the rapid advances in the types and applications of nanomaterials and the slower...... and the environment. A unique feature of this workshop was its interdisciplinary nature and focus on the practical needs of policy decision makers. Workshop presentations and discussion panels were structured along four main themes: technology and benefits, human health risk, environmental risk, and policy...

  14. Toward a New U.S. Chemicals Policy: Rebuilding the Foundation to Advance New Science, Green Chemistry, and Environmental Health

    Science.gov (United States)

    Wilson, Michael P.; Schwarzman, Megan R.

    2009-01-01

    Objective We describe fundamental weaknesses in U.S. chemicals policy, present principles of chemicals policy reform, and articulate interdisciplinary research questions that should be addressed. With global chemical production projected to double over the next 24 years, federal policies that shape the priorities of the U.S. chemical enterprise will be a cornerstone of sustainability. To date, these policies have largely failed to adequately protect public health or the environment or motivate investment in or scientific exploration of cleaner chemical technologies, known collectively as green chemistry. On this trajectory, the United States will face growing health, environmental, and economic problems related to chemical exposures and pollution. Conclusions Existing policies have produced a U.S. chemicals market in which the safety of chemicals for human health and the environment is undervalued relative to chemical function, price, and performance. This market barrier to green chemistry is primarily a consequence of weaknesses in the Toxic Substances Control Act. These weaknesses have produced a chemical data gap, because producers are not required to investigate and disclose sufficient information on chemicals’ hazard traits to government, businesses that use chemicals, or the public; a safety gap, because government lacks the legal tools it needs to efficiently identify, prioritize, and take action to mitigate the potential health and environmental effects of hazardous chemicals; and a technology gap, because industry and government have invested only marginally in green chemistry research, development, and education. Policy reforms that close the three gaps—creating transparency and accountability in the market—are crucial for improving public and environmental health and reducing the barriers to green chemistry. The European Union’s REACH (Registration, Evaluation, Authorisation and Restriction of Chemicals) regulation has opened an opportunity for

  15. A retrospective health policy analysis of the development and implementation of the voluntary health insurance system in Lebanon: learning from failure.

    Science.gov (United States)

    El-Jardali, Fadi; Bou-Karroum, Lama; Ataya, Nour; El-Ghali, Hana Addam; Hammoud, Rawan

    2014-12-01

    Public policymaking is complex and suffers from limited uptake of research evidence, particularly in the Eastern Mediterranean Region (EMR). In-depth case studies examining health policymaking in the EMR are lacking. This retrospective policy analysis aims at generating insights about how policies are being made, identifying factors influencing policymaking and assessing to what extent evidence is used in this process by using the Lebanese Voluntary Health Insurance policy as a case study. The study examined the policymaking process through a policy tracing technique that covered a period of 12 years. The study employed a qualitative research design using a case study approach and was conducted in two phases over the course of two years. Data was collected using multiple sources including: 1) a comprehensive and chronological media review; 2) twenty-two key informant interviews with policymakers, stakeholders, and journalists; and 3) a document review of legislations, minutes of meetings, actuarial studies, and official documents. Data was analyzed and validated using thematic analysis. Findings showed that the voluntary health insurance policy was a political decision taken by the government to tackle an urgent political problem. Evidence was not used to guide policy development and implementation and policy implementers and other stakeholders were not involved in policy development. Factors influencing policymaking were political interests, sectarianism, urgency, and values of policymakers. Barriers to the use of evidence were lack of policy-relevant research evidence, political context, personal interests, and resource constraints. Findings suggest that policymakers should be made more aware of the important role of evidence in informing public policymaking and the need for building capacity to develop, implement and evaluate policies. Study findings are likely to matter in light of the changes that are unfolding in some Arab countries and the looming

  16. 金融排斥:货币政策失效的另一种解释%Financial Exclusion:Another Explanation to the Failure of Monetary Policy

    Institute of Scientific and Technical Information of China (English)

    张文中

    2012-01-01

    至今为止,关于货币政策有效性的研究一直存在争议并受到学者和政策调控部门的持续关注。各种学派在理论上对货币政策有效与否的争论并没有阻碍学者们对现实货币政策有效性的探讨,大量研究都集中在货币传导机制本身及其影响因素上。本文从金融排斥角度解读货币政策可能失效的原因,并指出忽视金融排斥存在的货币政策可能导致的问题,从而赋予金融包容政策新的职能。%So far,researches on the effectiveness of monetary policy has been controversial and subject to the sustained attention of scholars and policy control departments.The validity of the monetary policy debate of the various schools,in theory,has not prevented scholars of reality the effectiveness of monetary policy,a large number of studies have focused on the monetary transmission mechanism and its influencing factors.Interpreting the possible reasons for the failure of monetary policy from financial exclusion angle,the paper pointed out that the ignorance of the financial exclusion of the existence of monetary policy could lead to problems,giving the financial policy of inclusion of new functions.

  17. Repetir ou progredir?uma análise da repetência nas escolas públicas de Minas Gerais Repeating or advancing?an analysis of school failure in public schools of Minas Gerais

    Directory of Open Access Journals (Sweden)

    Juliana de Lucena Ruas Riani

    2012-09-01

    longitudinal data that would allow a more accurate comparison between those pupils who failed and those that advanced, considering their performance before and after the school failure, the majority of studies focus primarily on the impact of the policies of cycles on the performance of the pupil. Using data from the Literacy Assessment Program (and external assessment conducted every year in public schools of the State of Minas Gerais, it was possible to set up a longitudinal database to identify pupils that had repeated and those who had not. To try to explain the performance of students who had failed and those who had not, we tried to use as a guiding line the approach based on the Educational Production Function, having as a methodological basis the hierarchical models. The results indicate that both categories of students - those who had failed and those who had not - displayed very important growth in proficiency average rates. However, the hierarchical models constructed demonstrated that, between two pupils with the same proficiency in 2008, one of them having failed and the other not, the pupil that did not fail tended to present the better proficiency level in 2009. Another important finding refers to the fact that the result of the pupil is very much influenced by the general result of the school.

  18. Usefulness of brain natriuretic peptide level at implant in predicting mortality in patients with advanced but stable heart failure receiving cardiac resynchronization therapy.

    Science.gov (United States)

    El-Saed, Aiman; Voigt, Andrew; Shalaby, Alaa

    2009-11-01

    Brain natriuretic peptide (BNP) level has emerged as a predictor of death and hospital readmission in patients with heart failure (HF). The value of baseline BNP assessment in advanced HF patients receiving cardiac resynchronization defibrillator therapy (CRT-D) has not been firmly established. We hypothesized that a baseline BNP level would predict all cause mortality and HF hospitalization in HF patients receiving cardiac resynchronization therapy. A retrospective chart review of all patients having BNP assessment prior to implantation of a CRT-D for standard indications during 2004 and 2005 was conducted at the Veterans Affairs Pittsburgh Healthcare System. The primary endpoint was all-cause mortality and the secondary endpoint was HF-related hospitalization. We used findings from the receiver operating characteristic (ROC) curve to define low ( or =492 pg/mL) BNP groups. Out of 173 CRT-D recipients, 115 patients (mean age 67.0 +/- 10.7 years, New York Heart Association [NYHA] class 2.9 +/- 0.3, left ventricular ejection fraction [LVEF] 22.5% +/- 9.6%, QRS 148.3 +/- 30.4 ms) had preimplantation BNP measured (mean 559 +/- 761 pg/mL and median 315 pg/mL). During a mean follow-up time of 17.5 +/- 6.5 mo, 27 deaths (23.5%) and 31 HF hospitalizations (27.0%) were recorded. Compared to those with low BNP (n = 74), those of high BNP (n = 41) were older, had lower LVEF, higher creatinine levels, suffered more deaths, and HF hospitalizations. In multivariate regression models, higher BNP remained a significant predictor of both the primary endpoint (hazard ratio [HR]: 2.89, 95% confidence interval [CI] 1.06-7.88, p = 0.038) and secondary endpoint (HR: 4.23, 95% CI: 1.68-10.60, p = 0.002). Baseline BNP independently predicted mortality and HF hospitalization in a predominantly older white male population of advanced HF patients receiving CRT-D. Elevated BNP levels may identify a vulnerable HF population with a particularly poor prognosis despite CRT-D.

  19. Biomass for biodiesel production on family farms in Brazil: promise or failure? : integrated assessment of biodiesel crops, farms, policies and producer organisations

    NARCIS (Netherlands)

    Belo Leite, Dal J.G.

    2013-01-01

    In Brazil, a biodiesel policy was implemented as a way of reducing poverty among family farms. The objective of this thesis is to perform an integrated assessment of biodiesel crops, farm types, biodiesel policies and producer organisations that reveals opportunities and limitations of family

  20. Biomass for biodiesel production on family farms in Brazil: promise or failure? : integrated assessment of biodiesel crops, farms, policies and producer organisations

    NARCIS (Netherlands)

    Belo Leite, Dal J.G.

    2013-01-01

    In Brazil, a biodiesel policy was implemented as a way of reducing poverty among family farms. The objective of this thesis is to perform an integrated assessment of biodiesel crops, farm types, biodiesel policies and producer organisations that reveals opportunities and limitations of family farmer

  1. Outcome and patterns of failure after postoperative intensity modulated radiotherapy for locally advanced or high-risk oral cavity squamous cell carcinoma

    Directory of Open Access Journals (Sweden)

    Geretschläger Andreas

    2012-10-01

    Full Text Available Abstract Background To determine the outcome and patterns of failure in oral cavity cancer (OCC patients after postoperative intensity modulated radiotherapy (IMRT with concomitant systemic therapy. Methods All patients with locally advanced (AJCC stage III/IV or high-risk OCC (AJCC stage II who underwent postoperative IMRT at our institution between December 2006 and July 2010 were retrospectively analyzed. The primary endpoint was locoregional recurrence-free survival (LRRFS. Secondary endpoints included distant metastasis-free survival (DMFS, overall survival (OS, acute and late toxicities. Results Overall 53 patients were analyzed. Twenty-three patients (43% underwent concomitant chemotherapy with cisplatin, two patients with carboplatin (4% and four patients were treated with the monoclonal antibody cetuximab (8%. At a median follow-up of 2.3 (range, 1.1–4.6 years the 3-year LRRFS, DMFS and OS estimates were 79%, 90%, and 73% respectively. Twelve patients experienced a locoregional recurrence. Eight patients, 5 of which had both a flap reconstruction and extracapsular extension (ECE, showed an unusual multifocal pattern of recurrence. Ten locoregional recurrences occurred marginally or outside of the high-risk target volumes. Acute toxicity grades of 2 (27% and 3 (66% and late toxicity grades of 2 (34% and 3 (11% were observed. Conclusion LRRFS after postoperative IMRT is satisfying and toxicity is acceptable. The majority of locoregional recurrences occurred marginally or outside of the high-risk target volumes. Improvement of high-risk target volume definition especially in patients with flap reconstruction and ECE might transfer into better locoregional control.

  2. The Model for End-Stage Liver Disease (MELD) can predict outcomes in ambulatory patients with advanced heart failure who have been referred for cardiac transplantation evaluation

    OpenAIRE

    Szyguła-Jurkiewicz, Bożena; Zakliczyński, Michał; Andrejczuk, Mariusz; Mościński, Mateusz; Zembala, Marian

    2014-01-01

    Risk stratification in heart failure (HF) patients is an important element for management. There are several risk stratification models that can be used to predict the prognosis of patients with HF, such as Aaronson's scale, CVM-HF (CardioVascular Medicine Heart Failure), the Seattle Heart Failure Model (SHFM) and the Munich score. These models fail to adequately address the impact of multiorgan dysfunction on prognosis. The classical Model for End-Stage Liver Disease (MELD) score consists of...

  3. Edmund W. Gordon: Producing Knowledge, Pursuing Understanding. Advances in Education in Diverse Communities: Research, Policy, and Praxis, Volume 1.

    Science.gov (United States)

    Yeakey, Carol Camp, Ed.

    This volume focuses on the work of Edmund W. Gordon and the influence he has had on contemporary thinking in psychology, education, and social policy, and the implications of his work for the schooling of lower-status youth and children of color in the United States. The chapters are: (1) "The Social Context of Emotions in Black Adolescents:…

  4. Development and testing of advanced redundancy management methods for the F-8 DFBW aircraft. [failure detection for Digital Fly By Wire systems

    Science.gov (United States)

    Deyst, J.; Deckert, J.; Desai, M.; Willsky, A.

    1977-01-01

    A reliable aircraft sensor failure detection and identification (FDI) technique is presented. The technique exploits the kinematic and dynamic relationships that exist between variables measured by dissimilar sensors to identify failures in the sensors. The method is applied to management of dual redundant sensors on the NASA F-8 digital fly-by-wire (DFBW) research aircraft.

  5. Policy Failures in the Graveyard of Empires: How Policymakers Let the Soldiers Down in the British, the Soviet, and the American Wars in Afghanistan

    Science.gov (United States)

    2011-05-19

    consistent errors of policy, the paper concludes that the incompetence and myopia of the policymakers is responsible for squandering the military gains...U.S.-NATO effort. Based on some strikingly common and consistent errors of policy, the paper concludes that the incompetence and myopia of the...War Against Al Qaeda,” Stratfor Global Intelligence , January 26, 2009, http://www.stratfor.com/weekly

  6. Advancing the strategic use of HIV operations research to strengthen local policies and programmes: the Research to Prevention Project.

    Science.gov (United States)

    Kerrigan, Deanna; Kennedy, Caitlin E; Cheng, Alison Surdo; Sandison, Sarah J; Fonner, Virginia A; Holtgrave, David R; Brahmbhatt, Heena

    2015-01-01

    In the field of HIV prevention, there is renewed interest in operations research (OR) within an implementation science framework. The ultimate goal of such studies is to generate new knowledge that can inform local programmes and policies, thus improving access, quality, efficiency and effectiveness. Using four case studies from the USAID-funded Research to Prevention (R2P) project, we highlight the strategic use of OR and the impact it can have on shaping the focus and content of HIV prevention programming across geographic and epidemic settings and populations. These case studies, which include experiences from several sub-Saharan African countries and the Caribbean, emphasize four unique ways that R2P projects utilized OR to stimulate change in a given context, including: (1) translating findings from clinical trials to real-world settings; (2) adapting promising structural interventions to a new context; (3) tailoring effective interventions to underserved populations; and (4) prioritizing key populations within a national response to HIV. Carefully crafted OR can bridge the common gap that exists between research-generated knowledge and field-based practice, lead to substantial, real-world changes in national policies and programmes, and strengthen local organizations and the use of data to be more responsive to a given topic or population, ultimately supporting a locally tailored HIV response.

  7. The Edmonton Public Schools Story: Internationally Renowned Superintendent Angus McBeath Chronicles His District's Successes and Failures. Policy Brief. No. S2007-13

    Science.gov (United States)

    McBeath, Angus

    2007-01-01

    This publication is a transcript of Superintendent Angus McBeath's presentation to legislators and media at an Issues and Ideas Forum hosted by the Mackinac Center for Public Policy in Lansing, Michigan. McBeath discusses education reform in Edmonton, Alberta, Canada, including: (1) Basic Elements of Reform; (2) School Employee Union Involvement;…

  8. Entrepreneurship Policies: Principles, Problems and Opportunities

    OpenAIRE

    Karlsson, Charlie; Andersson, Martin

    2009-01-01

    In this paper, we discuss the current status of the literature on entrepreneurship policy. The purpose is to discuss and assess several fundamental questions pertaining to entrepreneurship policies, such as “What is the optimal rate of entrepreneurship?” and “What entrepreneurship policies to pursue to remedy market failures and to avoid policy failures?”. In the entrepreneurship policies literature several contributors make distinctions between five types of entrepreneurship policy: governme...

  9. 慢性心力衰竭与贫血的相关性及治疗进展%The recent advances in the treatment and the correlation for chronic heart failure and of anemia

    Institute of Scientific and Technical Information of China (English)

    陈小玲; 吴新华; 陈章荣

    2016-01-01

    Chronic heart failure is the end-stage performance of the cardiovascular disease, and the main cause of death, serious harm human health.It is common in patients with anemia. The worse of patient age and heart function, the higher the incidence of anemia. Epidemiological survey data show that both at home and abroad about 1/5 to 1/3 of the patients with heart failure anemia maybe merge. Severe heart failure patient anaemia could be as high as 50% above. This paper reviews the advances in the treatment and anemia and the correlation of heart failure.%慢性心力衰竭(简称心衰)是心血管疾病的终末期表现和最主要的死因,严重危害人类健康。心衰患者常合并贫血,且患者年龄越大,心功能越差,贫血发生率越高。国内外流行病学调查资料[1]显示约1/5~1/3的心衰患者可能合并贫血,心衰程度严重者合并贫血率可能高达50%以上;本文旨在综述贫血与心衰的相关性及治疗进展。

  10. Heart Failure

    Science.gov (United States)

    ... heart failure due to systolic dysfunction. http://www.uptodate.com/home. Accessed Sept. 26, 2014. Colucci WS. ... patient with heart failure or cardiomyopathy. http://www.uptodate.com/home. Accessed Sept. 26, 2014. Colucci WS. ...

  11. Emerging methods and tools for environmental risk assessment, decision-making, and policy for nanomaterials: summary of NATO Advanced Research Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Linkov, Igor, E-mail: Igor.Linkov@usace.army.mi [U.S. Army Corps of Engineers, Environmental Laboratory (United States); Steevens, Jeffery, E-mail: Jeffery.A.Steevens@us.army.mi [U.S. Army ERDC (United States); Adlakha-Hutcheon, Gitanjali, E-mail: Gitanjali.Adlakha-Hutcheon@drdc-rddc.gc.c [Defense Research and Development Canada (Canada); Bennett, Erin, E-mail: ebennett@bioengineering.co [Intertox Inc. and Bioengineering Group (United States); Chappell, Mark, E-mail: Mark.a.chappell@usace.army.mi [U.S. Army Corps of Engineers, Environmental Laboratory (United States); Colvin, Vicki, E-mail: colvin@rice.ed [Rice University, ICON (United States); Davis, J. Michael, E-mail: Davis.Jmichael@epa.go [Office of Research and Development, U.S. Environmental Protection Agency, National Center for Environmental Assessment (United States); Davis, Thomas, E-mail: ta.davis@umontreal.c [University of Montreal, Environment Canada and Department of Chemistry (Canada); Elder, Alison, E-mail: Alison_Elder@urmc.rochester.ed [University of Rochester, Department of Environmental Medicine (United States); Foss Hansen, Steffen, E-mail: sfh@er.dtu.d [Technical University of Denmark, Department of Environmental Engineering, NanoDTU (Denmark); Hakkinen, Pertti Bert, E-mail: berthakkinen@gmail.co [Toxicology Excellence for Risk Assessment (TERA) (United States); Hussain, Saber M., E-mail: Saber.Hussain@wpafb.af.mi [Air Force Research Laboratory (United States); Karkan, Delara, E-mail: Delara_karkan@hc-sc.gc.c [Health Canada (Canada); Korenstein, Rafi, E-mail: korens@post.tau.ac.i [Marian Gertner Institute for Medical Nanosystems, Tel Aviv University, Department of Physiology and Pharmacology, Faculty of Medicine (Israel); Lynch, Iseult, E-mail: iseult@fiachra.ucd.i [School of Chemistry and Chemical Biology, University College Dublin, Irish Centre for Colloid Science and Biomaterials (Ireland); Metcalfe, Chris, E-mail: cmetcalfe@trentu.c [Trent University (Canada)

    2009-04-15

    Nanomaterials and their associated technologies hold promising opportunities for the development of new materials and applications in a wide variety of disciplines, including medicine, environmental remediation, waste treatment, and energy conservation. However, current information regarding the environmental effects and health risks associated with nanomaterials is limited and sometimes contradictory. This article summarizes the conclusions of a 2008 NATO workshop designed to evaluate the wide-scale implications (e.g., benefits, risks, and costs) of the use of nanomaterials on human health and the environment. A unique feature of this workshop was its interdisciplinary nature and focus on the practical needs of policy decision makers. Workshop presentations and discussion panels were structured along four main themes: technology and benefits, human health risk, environmental risk, and policy implications. Four corresponding working groups (WGs) were formed to develop detailed summaries of the state-of-the-science in their respective areas and to discuss emerging gaps and research needs. The WGs identified gaps between the rapid advances in the types and applications of nanomaterials and the slower pace of human health and environmental risk science, along with strategies to reduce the uncertainties associated with calculating these risks.

  12. Emerging methods and tools for environmental risk assessment, decision-making, and policy for nanomaterials: summary of NATO Advanced Research Workshop.

    Science.gov (United States)

    Linkov, Igor; Steevens, Jeffery; Adlakha-Hutcheon, Gitanjali; Bennett, Erin; Chappell, Mark; Colvin, Vicki; Davis, J Michael; Davis, Thomas; Elder, Alison; Foss Hansen, Steffen; Hakkinen, Pertti Bert; Hussain, Saber M; Karkan, Delara; Korenstein, Rafi; Lynch, Iseult; Metcalfe, Chris; Ramadan, Abou Bakr; Satterstrom, F Kyle

    2009-04-01

    Nanomaterials and their associated technologies hold promising opportunities for the development of new materials and applications in a wide variety of disciplines, including medicine, environmental remediation, waste treatment, and energy conservation. However, current information regarding the environmental effects and health risks associated with nanomaterials is limited and sometimes contradictory. This article summarizes the conclusions of a 2008 NATO workshop designed to evaluate the wide-scale implications (e.g., benefits, risks, and costs) of the use of nanomaterials on human health and the environment. A unique feature of this workshop was its interdisciplinary nature and focus on the practical needs of policy decision makers. Workshop presentations and discussion panels were structured along four main themes: technology and benefits, human health risk, environmental risk, and policy implications. Four corresponding working groups (WGs) were formed to develop detailed summaries of the state-of-the-science in their respective areas and to discuss emerging gaps and research needs. The WGs identified gaps between the rapid advances in the types and applications of nanomaterials and the slower pace of human health and environmental risk science, along with strategies to reduce the uncertainties associated with calculating these risks.

  13. Reduction of psycho-spiritual distress of an elderly with advanced congestive heart failure by life review interview in a palliative care day center

    Directory of Open Access Journals (Sweden)

    Kwok-Ying Chan

    2016-08-01

    Full Text Available Objectives: Major depression is common in patients hospitalized with congestive heart failure and is independently associated with increased re-hospitalization and mortality. Methods: Hereby, we report the treatment for an elderly congestive heart failure patient with frequent emergency department visits having major depression and hopelessness. Results: Treatment outcomes measured showed that depressed scores of psychosocial needs were reduced with life review interview therapy in a palliative care day center. Conclusion: We hypothesize that multidisciplinary team’s approach to treatment was important for this case.

  14. Unpredictability of intravenous busulfan pharmacokinetics in children undergoing hematopoietic stem cell transplantation for advanced beta thalassemia: limited toxicity with a dose-adjustment policy.

    Science.gov (United States)

    Chiesa, Robert; Cappelli, Barbara; Crocchiolo, Roberto; Frugnoli, Ilaria; Biral, Erika; Noè, Anna; Evangelio, Costanza; Fossati, Marco; Roccia, Tito; Biffi, Alessandra; Finizio, Valentina; Aiuti, Alessandro; Broglia, Monica; Bartoli, Antonella; Ciceri, Fabio; Roncarolo, Maria Grazia; Marktel, Sarah

    2010-05-01

    beta-thalassemia is a major health problem worldwide, and stem cell transplantation (SCT) is the only curative option. Oral Busulfan (Bu) based conditioning is widely used in this setting. Due to the variability of Bu systemic exposure, intravenous (i.v.) Bu has been proposed as a standard of care, with no need for drug monitoring and dose adjustment. Patients with beta-thalassemia from countries with limited resources might be at higher risk of erratic Bu metabolism because of liver dysfunction, severe iron overload, and specific ethnic/genetic features. We studied Bu pharmacokinetics in 53 children with advanced beta-thalassemia from Middle Eastern countries who underwent a total of 57 matched related donor SCTs. Forty-two percent of the children required dose adjustment because they did not achieve the therapeutic window after the first dose. With a Bu dose-adjustment policy, regimen-related toxicity was limited. At a median follow-up of 564 days, the probabilities of 2-year survival, current thalassemia-free survival, rejection, and treatment-related mortality were 96%, 88%, 21%, and 4%, respectively. Conditioning with i.v. Bu and dose adjustment is feasible and well tolerated, although recurrence of thalassemia remains an unsolved problem in children with advanced disease. Copyright 2010 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  15. Industrial Policies in Colombia

    OpenAIRE

    Melendez, Marcela; Perry, Guillermo

    2010-01-01

    This paper surveys and analyzes industrial policies in Colombia, finding extensive use of productive development policies (PDPs) and despite claims of only moderate government intervention. Rarely explicitly associated with the need to address market failures, PDPs are instead associated with economic reactivation and vaguely defined “competitiveness.” There are also PDPs that address government failures considered unlikely to be corrected by first-best interventions. Colombia has made progre...

  16. Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

    Science.gov (United States)

    Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

    2017-01-01

    Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

  17. A comparison of low versus high heart rate in patients with atrial fibrillation and advanced chronic heart failure : Effects on clinical profile, neurohormones and survival

    NARCIS (Netherlands)

    Rienstra, Michiel; Van Gelder, Isabelle C; Van den Berg, Maarten P; Boomsma, Frans; Hillege, Hans L; Van Veldhuisen, Dirk J

    2006-01-01

    BACKGROUND: Atrial fibrillation is common in chronic heart failure. Long-term restoration of sinus rhythm is generally unsuccessful. It may be speculated that higher heart rates are unfavorable, since this may lead to tachycardiomyopathy, but there are no data which have examined this. METHODS AND

  18. Data Policy

    Directory of Open Access Journals (Sweden)

    Mark A Parsons

    2013-07-01

    Full Text Available The first purpose of data policy should be to serve the objectives of the organization or project sponsoring the collection of the data. With research data, data policy should also serve the broader goals of advancing scientific and scholarly inquiry and society at large. This is especially true with government-funded data, which likely comprise the vast majority of research data. Data policy should address multiple issues, depending on the nature and objectives of the data. These issues include data access requirements, data preservation and stewardship requirements, standards and compliance mechanisms, data security issues, privacy and ethical concerns, and potentially even specific collection protocols and defined data flows. The specifics of different policies can vary dramatically, but all data policies need to address data access and preservation. Research data gain value with use and must therefore be accessible and preserved for future access. This article focuses on data access. While policy might address multiple issues, at a first level it must address where the data stand on what Lyon (2009 calls the continuum of openness. Making data as openly accessible as possible provides the greatest societal benefit, and a central purpose of data policy is to work toward ethically open data access. An open data regime not only maximizes the benefit of the data, it also simplifies most of the other issues around effective research data stewardship and infrastructure development.

  19. Focus on renal congestion in heart failure

    OpenAIRE

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet

    2015-01-01

    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardia...

  20. Cardiopoietic cell therapy for advanced ischaemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial

    Science.gov (United States)

    Davison, Beth A.; Filippatos, Gerasimos S.; Radovanovic, Slavica; Beleslin, Branko; Merkely, Bela; Musialek, Piotr; Wojakowski, Wojciech; Andreka, Peter; Horvath, Ivan G.; Katz, Amos; Dolatabadi, Dariouch; El Nakadi, Badih; Arandjelovic, Aleksandra; Edes, Istvan; Seferovic, Petar M.; Obradovic, Slobodan; Vanderheyden, Marc; Jagic, Nikola; Petrov, Ivo; Atar, Shaul; Halabi, Majdi; Gelev, Valeri L.; Shochat, Michael K.; Kasprzak, Jaroslaw D.; Sanz-Ruiz, Ricardo; Heyndrickx, Guy R.; Nyolczas, Noémi; Legrand, Victor; Guédès, Antoine; Heyse, Alex; Moccetti, Tiziano; Fernandez-Aviles, Francisco; Jimenez-Quevedo, Pilar; Bayes-Genis, Antoni; Hernandez-Garcia, Jose Maria; Ribichini, Flavio; Gruchala, Marcin; Waldman, Scott A.; Teerlink, John R.; Gersh, Bernard J.; Povsic, Thomas J.; Henry, Timothy D.; Metra, Marco; Hajjar, Roger J.; Tendera, Michal; Behfar, Atta; Alexandre, Bertrand; Seron, Aymeric; Stough, Wendy Gattis; Sherman, Warren; Cotter, Gad; Wijns, William

    2017-01-01

    Aims Cardiopoietic cells, produced through cardiogenic conditioning of patients’ mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. Methods and results This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein–Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann–Whitney estimator 0.54, 95% confidence interval [CI] 0.47–0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200–370 mL (60% of patients) (Mann–Whitney estimator 0.61, 95% CI 0.52–0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. Conclusion The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted. PMID:28025189

  1. U.S. Policy Toward the Israeli-Egyptian Conflict September 1970-February 1972: The Analysis of a Failure of American Diplomacy.

    Science.gov (United States)

    1983-12-01

    deliveries to Israel as an effective means of pressure. [Ref. 17: p. 132] Rogers responded that such a course was not a realis- tic option so long as the...substantial Israeli capacity to ignore dictation from the United States. They spoke of a new era in international poli- tics , in which clients manipulated...34As Egypt Marks Revolution’s Anniversary--Focus on Sadat’s Arab, Foreign, and Domestic Policy," The Arab World Weekly, pp. 5-10, 27 July 1974. Aulas , M

  2. Systems failure.

    OpenAIRE

    Macleod, Anna

    1998-01-01

    Systems Failure A solo exhibition of new work by Anna Macleod developed in conversation with curator Liz Burns. The Dock, Carrick on Shannon, Co Leitrim. Ireland. 12th February – 17th April 2010. The works for the exhibition Systems Failure include drawings, prints and small constructions that examine the delicate balance that exists between need and aspects of failure rooted in the relationship between humanity and land use. The work seeks to question the relationship between scient...

  3. The Model for End-Stage Liver Disease (MELD) can predict outcomes in ambulatory patients with advanced heart failure who have been referred for cardiac transplantation evaluation.

    Science.gov (United States)

    Szyguła-Jurkiewicz, Bożena; Zakliczyński, Michał; Andrejczuk, Mariusz; Mościński, Mateusz; Zembala, Marian

    2014-06-01

    Risk stratification in heart failure (HF) patients is an important element for management. There are several risk stratification models that can be used to predict the prognosis of patients with HF, such as Aaronson's scale, CVM-HF (CardioVascular Medicine Heart Failure), the Seattle Heart Failure Model (SHFM) and the Munich score. These models fail to adequately address the impact of multiorgan dysfunction on prognosis. The classical Model for End-Stage Liver Disease (MELD) score consists of: total bilirubin, INR (international normalized ratio) and creatinine level. There are some modifications of the MELD scale: MELD-XI, which excludes the INR score; the mod-MELD score, in which INR is replaced with albumin levels; and MELD-Na, which consists of the bilirubin and creatinine levels, INR ratio and the sodium level. Therefore, the MELD score systems are markers of multisystem dysfunction (renal, cardiac, hepatic). It is important that they are composed of routinely collected laboratory measures which are easy to use.

  4. Exploration of an Optimal Policy for Water Resources Management Including the Introduction of Advanced Sewage Treatment Technologies in Zaozhuang City, China

    Directory of Open Access Journals (Sweden)

    Gengyu He

    2016-12-01

    Full Text Available Water shortage and water pollution are important factors restricting sustainable social and economic development. As a typical coal resource-exhausted city and a node city of the South-to-North Water Transfer East Route Project in China, Zaozhuang City’s water resources management faces multiple constraints such as transformation of economic development, restriction of groundwater exploitation, and improvement of water environment. In this paper, we develop a linear optimization model by input–output analysis to study water resources management with the introduction of three advanced sewage treatment technologies for pollutant treatment and reclaimed water production. The simulation results showed that from 2014 to 2020, Zaozhuang City will realize an annual GDP growth rate of 7.1% with an annual chemical oxygen demand (COD emissions reduction rate of 5.5%. The proportion of primary industry, secondary industry, and tertiary industry would be adjusted to 5.6%, 40.8%, and 53.6%, respectively. The amount of reclaimed water supply could be increased by 91% and groundwater supply could be decreased by 6%. Based on the simulation, this model proposes a scientific reference on water resources management policies, including water environment control, water supply plan, and financial subsidy, to realize the sustainable development of economy and water resources usage.

  5. Advances on chronic heart failure in minipig models%小型猪慢性心力衰竭模型研究进展

    Institute of Scientific and Technical Information of China (English)

    应陈艇; 樊紫瑜; 牛小龙

    2016-01-01

    慢性心力衰竭是一种复杂的心血管综合征,建立合适的慢性心力衰竭动物模型是研究慢性心力衰竭发病机制及相关药物治疗的关键。小型猪因其在病理生理、解剖结构等方面更接近人类,故建立小型猪慢性心力衰竭模型已成为研究热点。目前较成熟的小型猪慢性心力衰竭模型制备方法主要有心肌梗死型、前负荷过载型、后负荷过载型、药源型和心动过速型等。%Chronic heart failure(CHF) is a complex cardiovascular syndrome.The establishment of an appropri⁃ate animal model of CHF is crucial for the study of pathogenesis and pharmacotherapy in CHF.Porcine models of chronic heart failure have became imperative because minipig is closer to human in physiopathology and anatomy. In recent years,the commonly used methods of minipig models of CHF are myocardial infarction,volume over⁃load,pressure overload,drug⁃induced and ventricular rapid pacing.

  6. Pathophysiology of heart failure.

    Science.gov (United States)

    Chiariello, M; Perrone-Filardi, P

    1999-01-01

    Heart failure is a leading cause of mortality and morbidity in Western countries. Common etiology is mostly represented by ischemic and hypertensive heart disease. Clinically, heart failure can be defined as an impaired cardiac performance, unable to meet the energy requirements of the periphery. Pathophysiologically, the clinical onset of heart failure symptoms already represents an advanced stage of disease when compensatory mechanisms triggered by the underlying decrease in contractility are no longer capable of maintaining adequate cardiac performance during exercise and, subsequently, under resting conditions. Independent of its underlying etiology, cardiac failure is always characterized by an impairment in the intrinsic contractility of myocytes. As a consequence of reduced contractility, a number of central and peripheral compensatory mechanisms take place that are capable of effectively counteracting reduced intravascular intrinsic performance for a long period of time. Among them, recruitment of preload reserve, enhanced neurohormonal stimulation and cardiac hypertrophy are the most important. All of them, however, also carry unfavorable effects that contribute to further deterioration of cardiac function. In fact, increased end-diastolic volume determines increased wall stress that further reduces systolic performance; sympathetic and angiotensin stimulation increases peripheral resistance and contributes to increase volume expansion; hypertrophic myocytes demonstrate impaired intrinsic contractility and relaxation, and hypertrophy causes a clinically relevant deterioration of ventricular relaxation and compliance that substantially participates in increased end-diastolic pressure, and, therefore, to limited exercise performance. Diastolic dysfunction usually accompanies systolic dysfunction, although in some cases it may represent the prevalent mechanism of congestive heart failure in patients in whom systolic performance is preserved. Biological causes

  7. Using medical imaging for the detection of adverse events ("incidents") during the utilization of left ventricular assist devices in adult patients with advanced heart failure.

    Science.gov (United States)

    Kaufmann, Friedrich; Krabatsch, Thomas

    2016-05-01

    Ventricular assist devices (VAD) are used for mechanical support of the terminally failing heart. Failure of these life supporting systems can be fatal. Early and reliable detection of any upcoming problems is mandatory and is crucial for the outcome. Medical imaging methods are described within this review, which are not only essential for diagnosis of typically VAD-related complications but also for the detection or verification of technical issues. Within this review the utilization of medical imaging equipment for the diagnosis of technical malfunctions or damages of implanted system components is discussed. A newly developed specialized acoustic imaging method for pump thrombosis detection will also be described along with the most common VAD-related medical complications and their respective imaging methods and the limitations induced by the use of the VAD-system.

  8. Continuous-flow left ventricular assist device support in patients with advanced heart failure: points of interest for the daily management.

    Science.gov (United States)

    Felix, S E A; Martina, J R; Kirkels, J H; Klöpping, C; Nathoe, H; Sukkel, E; Hulstein, N; Ramjankhan, F Z; Doevendans, P A F M; Lahpor, J R; de Jonge, Nicholaas

    2012-04-01

    Today, continuous-flow left ventricular assist devices (cf-LVADs) are implanted more often in patients with end-stage heart failure. Because of greater durability they can be implanted for an extended period of time. As a result of increased numbers of patients on cf-LVAD support, healthcare professionals should be aware of the potential complications inherent to this therapy. Both bleeding and thrombosis may occur, and also complications related either to the device itself or to the ensuing altered haemodynamics, valvular pathology, and rhythm disturbances such as ventricular tachycardias and fibrillation. Accurate clinical evaluation, together with an electrocardiogram and, if necessary, combined with an echocardiogram, is obligatory in these situations. This review summarizes common complications complemented by a few clinical cases.

  9. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008275 Relationship of calcineure in mRNA level in peripheral blood and cardiac muscle of patients with heart failure.WANG Mengmeng(王萌萌),et al.Dept Cardiol,Shandong Prov Hosp,Shandong Univ,Jinan 250021.Chin Cir J 2008;23(2):113-116.Objective To study the relationship of calcineurin mRNA level between peripheral lymphocytes and cardiac muscles of patients with chronic heart failure.Methods

  10. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008037 Factors associated with efficacy of cardiac resynchronization therapy for patients with congestive heart failure. SHI Haoying(史浩颖), et al. Dept Cardiol, Zhongshan Hosp Fudan Univ, Shanghai 200032. Chin J Cardiol 2007;35(12):1099-1163. Objective The efficacy of cardiac resynchronization therapy (CRT) in patients with congestive heart failure and the potential factors associated with responder or nonresponder were investigated. Methods Fifty

  11. Checking Security Policy Compliance

    CERN Document Server

    Gowadia, Vaibhav; Kudo, Michiharu

    2008-01-01

    Ensuring compliance of organizations to federal regulations is a growing concern. This paper presents a framework and methods to verify whether an implemented low-level security policy is compliant to a high-level security policy. Our compliance checking framework is based on organizational and security metadata to support refinement of high-level concepts to implementation specific instances. Our work uses the results of refinement calculus to express valid refinement patterns and their properties. Intuitively, a low-level security policy is compliant to a high-level security policy if there is a valid refinement path from the high-level security policy to the low-level security policy. Our model is capable of detecting violations of security policies, failures to meet obligations, and capability and modal conflicts.

  12. Different components of blood pressure are associated with increased risk of atherosclerotic cardiovascular disease versus heart failure in advanced chronic kidney disease.

    Science.gov (United States)

    Bansal, Nisha; McCulloch, Charles E; Lin, Feng; Robinson-Cohen, Cassianne; Rahman, Mahboob; Kusek, John W; Anderson, Amanda H; Xie, Dawei; Townsend, Raymond R; Lora, Claudia M; Wright, Jackson; Go, Alan S; Ojo, Akinlolu; Alper, Arnold; Lustigova, Eva; Cuevas, Magda; Kallem, Radhakrishna; Hsu, Chi-Yuan

    2016-12-01

    Blood pressure is a modifiable risk for cardiovascular disease (CVD). Among hemodialysis patients, there is a U-shaped association between blood pressure and risk of death. However, few studies have examined the association between blood pressure and CVD in patients with stage 4 and 5 chronic kidney disease. Here we studied 1795 Chronic Renal Insufficiency Cohort (CRIC) Study participants with estimated glomerular filtration rate 90 mm Hg versus 68 mm Hg versus 68 mm Hg versus <51 mmHg, but not for SBP or DBP. Thus, among participants with stage 4 and 5 chronic kidney disease, there was an independent association between higher SBP, DBP, and pulse pressure with the risk of atherosclerotic CVD, whereas only higher pulse pressure was independently associated with a greater risk of heart failure. Further trials are needed to determine whether aggressive reduction of blood pressure decreases the risk of CVD events in patients with stage 4 and 5 chronic kidney disease. Copyright © 2016 International Society of Nephrology. All rights reserved.

  13. [Neonatal hemochromatosis: Another entity that is no longer orphan. Advances in the diagnosis and management of the main cause of neonatal acute liver failure].

    Science.gov (United States)

    Molera Busoms, C; Quintero Bernabeu, J; Martín de Carpi, J

    2015-09-01

    Neonatal hemochromatosis is the most common cause of acute liver failure in the neonatal period. It is associated with high morbidity and mortality due to iron overload in hepatic and extra-hepatic tissues. New evidence has emerged during the last few years as regards its alloimmune etiology, which have had an important repercussion on the diagnosis, treatment and prognosis of these patients. Treatment with immunoglobulins and exchange transfusions has radically changed the prognosis without liver transplant. Another great success has been the preventive use of immunoglobulin in pregnant women with a past history of neonatal hemochromatosis, thus decreasing the rate of disease recurrence up to 70%. This new paradigm has led to an entity with a poor prognosis becoming a curable disease if diagnosed and treated early. Nevertheless, a large widespread ignorance of the disease persists, with medical implications that result in significant health problems, due to the delayed referral of these patients to specialized centers. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  14. Has UK energy policy failed

    Energy Technology Data Exchange (ETDEWEB)

    Parker, M.J. (Sussex University, Brighton (United Kingdom). Science Policy Research Unit)

    1993-01-01

    The coal crisis of last October focused attention on the UK's energy supplies and led many to criticise the government's energy policy. Are these criticisms justified Was the crisis a massive policy failure An Honorary Fellow at the Science Policy Research Unit at Sussex University and formerly Director of Economics at British Coal, assesses UK energy policy and highlights some of the outstanding issues. 1 tab.

  15. School failure.

    Science.gov (United States)

    Dworkin, P H

    1989-04-01

    Numerous factors may contribute to a child's failure to learn. Certain causes of school failure, such as specific learning disabilities, mental retardation, sensory impairment, and chronic illness may be regarded as intrinsic characteristics of the child. Other causes, such as family dysfunction, social problems, and ineffective schooling, are characteristics of the child's environment. Still other influences on school performance, such as temperamental dysfunction, attention deficits, and emotional illness, may be viewed as the consequence of the interaction between the child and his or her environment. The reasons for a child's school failure must not be considered in isolation but rather within the context of social and environmental circumstances. Evaluation must consider the myriad of reasons for a child's school failure and attempt to identify "clusters" of adverse influences on school performance. Detailed information must be sought from the student, parents, and school system through the history and physical examination. Questionnaires are useful in data gathering. Ancillary methods of assessment that may be of value include neurodevelopmental screening and laboratory studies. Further investigations and referrals, particularly psychoeducational evaluation, are of major importance. Traditional roles of the pediatrician in school failure include the treatment of underlying medical conditions, counseling, the coordination of further investigations and referrals, and the facilitation of communication with community services and resources. Participation with other disciplines in the development of a child's educational plan is feasible and useful.

  16. Biweekly cetuximab and irinotecan as third-line therapy in patients with advanced colorectal cancer after failure to irinotecan, oxaliplatin and 5-fluorouracil

    DEFF Research Database (Denmark)

    Pfeiffer, P.; Nielsen, Dorte; Bjerregaard, J.;

    2008-01-01

    Background: Standard weekly cetuximab and irinotecan (CetIri) is an effective regimen in heavily pretreated patients with advanced colorectal cancer (ACRC). Inspired by a pharmacokinetic study demonstrating no differences between weekly and biweekly cetuximab, we present the results of 74......-resulting in an overall treatment time of 90 min. Results: All patients had ACRC resistant to 5-fluorouracil and irinotecan and 95% to oxaliplatin. Median age was 63 years, median performance status was 0. Median duration of therapy was 4.3 months. Response rate was 25%. Median progression-free survival and overall...... survival were 5.4 months and 8.9 months, respectively, comparable to own historical controls receiving weekly CetIri. Grade 3-4 toxicity was rare (skin 7%, nail 3%, diarrhoea 10%, fatigue 3%, neutropenia 9%). One patient experienced severe allergic reaction. Conclusion: Salvage therapy with simplified...

  17. Cetuximab and irinotecan as third line therapy in patients with advanced colorectal cancer after failure of irinotecan, oxaliplatin and 5-fluorouracil

    DEFF Research Database (Denmark)

    Pfeiffer, Per; Nielsen, Dorte; Yilmaz, Mette

    2007-01-01

    Cetuximab (Erbitux) in combination with irinotecan is the most promising combination in heavily pretreated patients with advanced colorectal cancer. Efficacy of this combination was confirmed in the pivotal BOND I study. The aim of the present study was to evaluate efficacy and toxicity of a comb...... grade 3 was rare (skin toxicity 8%, diarrhoea 10%, nausea 3%, vomiting 3%, fatigue 8%). Salvage therapy with cetuximab and irinotecan is effective in patients pretreated with irinotecan, and oxaliplatin and in a general population the results from the BOND I study was confirmed...... of a combination regimen of cetuximab and irinotecan but in contrast to the BOND I study all patients had previously received 5-FU, oxaliplatin and irinotecan and all had progressed during or shortly after completion of treatment. Before January 2005 salvage therapy with cetuximab and irinotecan was not used...

  18. Leveraging U.S. nuclear weapons policy to advance U.S. nonproliferation goals : implications of major theories of international relations.

    Energy Technology Data Exchange (ETDEWEB)

    Walter, Andrew

    2009-06-01

    National policymakers are currently considering a dilemma of critical importance to the continued security of the United States: how can U.S. nuclear weapons policies be leveraged to benefit U.S. nuclear nonproliferation goals in the near-term, without sacrificing U.S. national security? In its role supporting U.S. nuclear weapons policy, Sandia National Laboratories has a responsibility to provide objective technical advice to support policy deliberations on this question. However, to best fulfill this duty Sandia must have a broader understanding of the context of the problem. To help develop this understanding, this paper analyzes the two predominant analytical perspectives of international relations theory to explore their prescriptions for how nuclear weapons and nonproliferation policies interact. As lenses with which to view and make sense of the world, theories of international relations must play a crucial role in framing the trade-offs at the intersection of the nuclear weapons and nonproliferation policy domains. An analysis of what these theories suggest as courses of action to leverage nuclear weapons policies to benefit nonproliferation goals is then offered, with particular emphasis on where the policy prescriptions resulting from the respective theories align to offer near-term policy changes with broad theoretical support. These policy prescriptions are then compared to the 2001 Nuclear Posture Review to understand what the theories indicate policymakers may have gotten right in their dealing with the nuclear dilemma, and where they may have gone wrong. Finally, a brief international relations research agenda is proposed to help address the dilemma between nuclear deterrence and nuclear nonproliferation policies, with particular emphasis on how such an agenda can best support the needs of the policy community and a potential 'all things nuclear' policy deliberation and decision-support framework.

  19. Predicting drowsy driving in real-time situations: Using an advanced driving simulator, accelerated failure time model, and virtual location-based services.

    Science.gov (United States)

    Wang, Junhua; Sun, Shuaiyi; Fang, Shouen; Fu, Ting; Stipancic, Joshua

    2017-02-01

    This paper aims to both identify the factors affecting driver drowsiness and to develop a real-time drowsy driving probability model based on virtual Location-Based Services (LBS) data obtained using a driving simulator. A driving simulation experiment was designed and conducted using 32 participant drivers. Collected data included the continuous driving time before detection of drowsiness and virtual LBS data related to temperature, time of day, lane width, average travel speed, driving time in heavy traffic, and driving time on different roadway types. Demographic information, such as nap habit, age, gender, and driving experience was also collected through questionnaires distributed to the participants. An Accelerated Failure Time (AFT) model was developed to estimate the driving time before detection of drowsiness. The results of the AFT model showed driving time before drowsiness was longer during the day than at night, and was longer at lower temperatures. Additionally, drivers who identified as having a nap habit were more vulnerable to drowsiness. Generally, higher average travel speeds were correlated to a higher risk of drowsy driving, as were longer periods of low-speed driving in traffic jam conditions. Considering different road types, drivers felt drowsy more quickly on freeways compared to other facilities. The proposed model provides a better understanding of how driver drowsiness is influenced by different environmental and demographic factors. The model can be used to provide real-time data for the LBS-based drowsy driving warning system, improving past methods based only on a fixed driving. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Iridium: failures & successes

    Science.gov (United States)

    Christensen, CarissaBryce; Beard, Suzette

    2001-03-01

    This paper will provide an overview of the Iridium business venture in terms of the challenges faced, the successes achieved, and the causes of the ultimate failure of the venture — bankruptcy and system de-orbit. The paper will address technical, business, and policy issues. The intent of the paper is to provide a balanced and accurate overview of the Iridium experience, to aid future decision-making by policy makers, the business community, and technical experts. Key topics will include the history of the program, the objectives and decision-making of Motorola, the market research and analysis conducted, partnering strategies and their impact, consumer equipment availability, and technical issues — target performance, performance achieved, technical accomplishments, and expected and unexpected technical challenges. The paper will use as sources trade media and business articles on the Iridium program, technical papers and conference presentations, Wall Street analyst's reports, and, where possible, interviews with participants and close observers.

  1. Cardiomyocytic apoptosis and heart failure

    Institute of Scientific and Technical Information of China (English)

    Quanzhou Feng

    2008-01-01

    Heart failure is a major disease seriously threatening human health.Once left ventricular dysfunction develops,cardiac function usually deteriorates and progresses to congestive heart failure in several months or years even if no factors which accelerate the deterioration repeatedly exist.Mechanism through which cardiac function continually deteriorates is still unclear.Cardiomyocytic apoptosis can occur in acute stage of ischemic heart diseases and the compensated stage of cardiac dysfunction.In this review,we summarize recent advances in understanding the role of cardiomyocytic apoptosis in heart failure.

  2. Collaboration and entanglement: An actor-network theory analysis of team-based intraprofessional care for patients with advanced heart failure.

    Science.gov (United States)

    McDougall, A; Goldszmidt, M; Kinsella, E A; Smith, S; Lingard, L

    2016-09-01

    Despite calls for more interprofessional and intraprofessional team-based approaches in healthcare, we lack sufficient understanding of how this happens in the context of patient care teams. This multi-perspective, team-based interview study examined how medical teams negotiated collaborative tensions. From 2011 to 2013, 50 patients across five sites in three Canadian provinces were interviewed about their care experiences and were asked to identify members of their health care teams. Patient-identified team members were subsequently interviewed to form 50 "Team Sampling Units" (TSUs), consisting of 209 interviews with patients, caregivers and healthcare providers. Results are gathered from a focused analysis of 13 TSUs where intraprofessional collaborative tensions involved treating fluid overload, or edema, a common HF symptom. Drawing on actor-network theory (ANT), the analysis focused on intraprofessional collaboration between specialty care teams in cardiology and nephrology. The study found that despite a shared narrative of common purpose between cardiology teams and nephrology teams, fluid management tools and techniques formed sites of collaborative tension. In particular, care activities involved asynchronous clinical interpretations, geographically distributed specialist care, fragmented forms of communication, and uncertainty due to clinical complexity. Teams 'disentangled' fluid in order to focus on its physiological function and mobilisation. Teams also used distinct 'framings' of fluid management that created perceived collaborative tensions. This study advances collaborative entanglement as a conceptual framework for understanding, teaching, and potentially ameliorating some of the tensions that manifest during intraprofessional care for patients with complex, chronic disease.

  3. Understanding the nano- and macromechanical behaviour, the failure and fatigue mechanisms of advanced and natural polymer fibres by Raman/IR microspectrometry

    Science.gov (United States)

    Colomban, Philippe

    2013-03-01

    The coupled mechanical and Raman/infrared (IR) analysis of the (nano)structure and texture of synthetic and natural polymer fibres (polyamides (PA66), polyethylene terephthalate (PET), polypropylene (PP), poly(paraphenylene benzobisoxazole) (PBO), keratin/hair, Bombyx mori, Gonometa rufobrunea/postica Antheraea/Tussah silkworms and Nephila Madagascarensis spider silks) is applied so as to differentiate between crystalline and amorphous macromolecules. Bonding is very similar in the two cases but a broader distribution of conformations is observed for the amorphous macromolecules. These conclusions are then used to discuss the modifications induced by the application of a tensile or compressive stress, including the effects of fatigue. Detailed attention is paid to water and the inter-chain coupling for which the importance of hydrogen bonding is reconsidered. The significant role of the ‘amorphous’ bonds/domains in the process of fracture/fatigue is shown. Invited talk at the 6th International Workshop on Advanced Materials Science and Nanotechnology IWAMSN2012, 30 October-2 November 2012, Ha Long, Vietnam.

  4. Advances on treating and diagnosing heart failure with preserved ejection fraction%射血分数保留心力衰竭诊疗进展

    Institute of Scientific and Technical Information of China (English)

    高淑贤; 贾辛未; 赵文萍

    2016-01-01

    Heart failure( HF) with preserved ejection fraction ( HFPEF) is a clinical syndrome of exercise intol-erance and/or congestion,in the presence of a left ventricular(LV) ejection fraction within the normal limits(i. e.LVEF>50%) .Determining the presence of impaired LV relaxation and/or filling ( diastolic dysfunction ) in HFPEF is needed to pragmatically to distinguish it from other cardiac and non-cardiac conditions where symptoms are not due to HF .There are multiple mechanisms for diastolic dysfunction ranging from structural abnormalities to functional derangements in HFPEF yet tailored therapies are lacking .Treatments proven effective in HF with systolic dysfunction have failed to show significant benefit in patients with HFPEF ,which prognosis remains poor . This review will discuss the HFPEF .%射血分数保留心力衰竭( HFPEF)是一种运动耐受减低和(或)组织充血为特征的一种临床综合征,而其左心室射血分数在正常范围内(例如LVEF>50%)。 HFPEF的诊断比射血分数减少心力衰竭( HFREF)的诊断更具挑战性,因为它需要排除大量其他潜在的提示心力衰竭症状的心源性及非心源性的诊断。舒张功能障碍由多种机制引起,包括心脏结构异常及功能异常,但个体化治疗仍缺乏。随着多年临床治疗发展, HFREF患者的获益明显提高,但是HFPEF患者的患病率及病死率却没有明显改变。

  5. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970318 A study on evoked potentials in cor pul-monale patients with chronic respiratory failure.QIAO Hui(乔慧), et al. Beijing Neurosurg Instit,Beijing, 100050. Chin J Geriatr 1997; 16(1): 43-45. Objective: Evoked protential was used to detect thechange of brain function in cor pulmonale patients with

  6. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    2009170 Curcumin attenuates left ventricular dysfunction and remodeling in rabbits with chronic heart failure. TANG Yanhong(唐艳红),et al.Dept Cardiol,Renmin Hosp,Wuhan Univ,Wuhan 430060.Chin J Cardiol,2009;37(3):262-267.

  7. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008411 Expression of S100B during heart failure in rats. JIANG Zhenni(蒋珍妮), et al. Dept Cardiol, 2nd Affili Hosp, Zhejiang Univ, Coll Med Hangzhou 310009. Chin J Emerg Med 2008;17(5):475-478. Objective To evaluate the value of S100B gene on cardiovascular remodeling in rats with abdominal aorta coarctation.

  8. Heart failure

    Institute of Scientific and Technical Information of China (English)

    1997-01-01

    970284 Effects of enalapril on heart rate variabilityin patients with congestive heart failure. ZHANGYouhua(章友华), et a1. Dept Cardiol, Cardiovasc Instit& Fuwai Hosp, CAMS & PUMC, Beijing, 100037. ChinCir J 1996; 11(2): 729-732.

  9. Failure Modes

    DEFF Research Database (Denmark)

    Jakobsen, K. P.; Burcharth, H. F.; Ibsen, Lars Bo;

    1999-01-01

    The present appendix contains the derivation of ten different limit state equations divided on three different failure modes. Five of the limit state equations can be used independently of the characteristics of the subsoil, whereas the remaining five can be used for either drained or undrained...

  10. Subsidizing Start-Ups: Policy Targeting and Policy Effectiveness

    OpenAIRE

    Kösters, Sarah

    2009-01-01

    Start-up subsidies are a frequently employed policy instrument, the use of which is justified by alleged market failure resulting from positive external effects and capital market imperfections. This article investigates whether the allocation of subsidies reflects a policy focus on addressing these market failure occurrences. However, using survey data from the East German state of Thuringia, logistic regressions reveal a rather random subsidization of start-ups. Furthermore, propensity scor...

  11. Problematizations in Health Policy

    Directory of Open Access Journals (Sweden)

    Carol Bacchi

    2016-06-01

    Full Text Available This article directs attention to the significance, for health promotion advocates, of reflecting on how “problems” are constituted, or brought into existence, as particular sorts of problems, within policies and policy proposals. To this end, it introduces a poststructural analytic strategy called “What’s the Problem Represented to be?” (WPR approach, and contrasts this perspective to the ways in which “problems” are commonly conceptualized in health policy analyses (e.g., “a problem stream,” “wicked problems”. Such a perspective offers a significant rethinking of the conventional emphasis on agenda setting and policy-making processes in considering the meaning of success or failure in health policy initiatives. The starting point is a close analysis of items that are “successful,” in the sense that they make the political agenda, to see how representations of “problems” within selected policies limit what is talked about as possible or desirable, or as impossible and undesirable. This form of analysis thus enables critical reflections on the substantive content of policy initiatives in health policy. The article takes a step back from policy process theories, frameworks, and models to offer reflections at the level of paradigms. Highlighting potential dangers and limitations in positivism, interpretivism, and critical realism, it uses international, Australian, and South Australian examples in health policy to explore what poststructural policy analysis contributes to understanding the broad political influences shaping contemporary modes of rule.

  12. Renal failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930150 Epidermal growth factor and its recep-tor in the renal tissue of patients with acute re-nal failure and normal persons.LIU Zhihong(刘志红),et al.Jinling Hosp,Nanjing,210002.Natl Med J China 1992;72(10):593-595.Epidermal growth factor(EGF)and its receptor(EGF-R)were identified by immunohis-tochemical method(4 layer PAP)in the renaltissue specimens obtained from 11 normal kid-neys and 17 cases of acute renal failure(ARF).The quantitative EGF and EGF-R in the tissuewere expressed as positive tubules per mm~2.The amount of EGF and EGF-R in renal tissue

  13. Heart failure

    Institute of Scientific and Technical Information of China (English)

    1992-01-01

    920647 Comparative effects of commonvasodilators on experimental cardiac fai-lure. LI Zhijian (李志坚), et al. Dept Cardiol,2nd Hosp, Tianjin Med Coll. Tianjin Med J1992; 20(8): 456-458. A 9×9 latin square design was employed forcomparing the effects of (1) placebo, (2) nitr-oprusside, (3) phentolamine, (4) isosorbide dini-trate. (5) captopril, (6) captopril-isosorbide

  14. Heart failure

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    2010316 Tissue doppler imaging observation on effect of long-term use of gingko biloba tabtet on left ventricular function in patients with chronic heart failure. ZHANG Hui(张辉),et al. Dept Cardiovasc Med, 2nd Hosp, Hebei Med Univ,Shijiazhuang 050000. Chin J Integr Tradit & West Med 2010;30(5):478-481. Objective To quantitatively observe the effect of long-term

  15. Renal failure

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    2008463 Protective effect of recombination rat augmenter of liver regeneration on kidney in acute renal failure rats. TANG Xiaopeng(唐晓鹏), et al. Dept Nephrol, 2nd Affili Hosp Chongqing Med Univ, Chongqing 400010.Chin J Nephrol 2008;24(6):417-421. Objective To investigate the protective effects of recombination rat augmenter of liver regeneration (rrALR) on tubular cell injury and renal dysfunction

  16. A Potentially Heteroglossic Policy Becomes Monoglossic in Context: An Ethnographic Analysis of Paraguayan Bilingual Education Policy

    Science.gov (United States)

    Mortimer, Katherine S.

    2016-01-01

    Ethnographic and discursive approaches to educational language policy (ELP) that explore how policy is appropriated in context are important for understanding policy success/failure in meeting goals of educational equity for language-minoritized students. This study describes how Paraguayan national policy for universal bilingual education…

  17. Heart failure - tests

    Science.gov (United States)

    CHF - tests; Congestive heart failure - tests; Cardiomyopathy - tests; HF - tests ... the best test to: Identify which type of heart failure (systolic versus diastolic, valvular) Monitor your heart failure ...

  18. Heart failure - home monitoring

    Science.gov (United States)

    ... failure - discharge Heart failure - fluids and diuretics Heart failure - what to ask ... Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, ...

  19. Parallel paths to improve heart failure outcomes

    DEFF Research Database (Denmark)

    Albert, Nancy M.

    2013-01-01

    Gaps and disparities in delivery of heart failure education by nurses and performance in accomplishing self-care behaviors by patients with advanced heart failure may be factors in clinical decompensation and unplanned consumption of health care. Is nurse-led education effectively delivered before...... and exercise. Further, clinical nurses may not have time to provide in-depth education to patients before discharge. Equally important, research is needed to learn about factors that enhance patients’ adherence to heart failure self-care behaviors, because adherence to recommendations of national, evidence......-based, heart failure guidelines improves clinical outcomes. Thus, nurses and patients are on parallel paths related to setting the foundation for improved self-care adherence in advanced heart failure. Through research, we found that nurses were not adequately prepared as heart failure educators...

  20. Sustainable cities and energy policies

    Energy Technology Data Exchange (ETDEWEB)

    Capello, R. [Politecnico di Milano (Italy). Dept. of Economics; Nijkamp, P.; Pepping, G. [Vrije Univ., Amsterdam (Netherlands). Dept. of Regional Economics

    1999-03-01

    This book starts out with the optimistic perspective that modern cities can indeed play a strategic role in the necessary pathway to sustainable development, with particular emphasis on the opportunities offered by local energy and environmental initiatives. Our study aims to demonstrate that an urban sustainability policy has many socio-economic benefits, while it also seeks to identify the critical success and failure factors of sustainable city innovations. After a comprehensive review of various opportunities and experiences, attention is focused particularly on renewable energy resources which may offer new potential for the active involvement of local authorities. The study also highlights major impediments regarding the adoption and implementation of renewable energies, in particular, the development of advanced energy-environmental technology in a world dominated by natural (public) monopolies and/or monopolistic competition elements. In this context both theoretical and empirical elements are discussed, as well as institutional aspects. The theory and methodology is tested by a thorough empirical investigation into local renewable energy initiatives in three European countries, viz. Greece, Italy and The Netherlands. Based on an extensive data base, various statistical models are estimated in order to identify the key elements and major driving forces of sustainable development at the city level. And finally, the study is concluded with a long list of applicable and operational policy guidelines for urban sustainability. These lessons are largely based on meta-analytic comparative studies of the various initiatives investigated. (orig.)

  1. Effects of low-dose oral enoximone administration on mortality, morbidity, and exercise capacity in patients with advanced heart failure: the randomized, double-blind, placebo-controlled, parallel group ESSENTIAL trials

    Science.gov (United States)

    Metra, Marco; Eichhorn, Eric; Abraham, William T.; Linseman, Jennifer; Böhm, Michael; Corbalan, Ramon; DeMets, David; De Marco, Teresa; Elkayam, Uri; Gerber, Michael; Komajda, Michel; Liu, Peter; Mareev, Vyacheslev; Perrone, Sergio V.; Poole-Wilson, Philip; Roecker, Ellen; Stewart, Jennifer; Swedberg, Karl; Tendera, Michal; Wiens, Brian; Bristow, Michael R.

    2009-01-01

    Aims Use of inotropic agents in patients with heart failure (HF) has been limited by adverse effects on outcomes. However, administration of positive inotropes at lower doses and concomitant treatment with beta-blockers might increase benefit–risk ratio. We investigated the effects of low doses of the positive inotrope enoximone on symptoms, exercise capacity, and major clinical outcomes in patients with advanced HF who were also treated with beta-blockers and other guideline-recommended background therapy. Methods and results The Studies of Oral Enoximone Therapy in Advanced HF (ESSENTIAL) programme consisted of two identical, randomized, double-blind, placebo-controlled trials that differed only by geographic location (North and South America: ESSENTIAL-I; Europe: ESSENTIAL-II). Patients with New York Heart Association class III–IV HF symptoms, left ventricular ejection fraction ≤30%, and one hospitalization or two ambulatory visits for worsening HF in the previous year were eligible for participation in the trials. The trials had three co-primary endpoints: (i) the composite of time to all-cause mortality or cardiovascular hospitalization, analysed in the two ESSENTIAL trials combined; (ii) the 6 month change from baseline in the 6 min walk test distance (6MWTD); and (iii) the Patient Global Assessment (PGA) at 6 months, both analysed in each trial separately. ESSENTIAL-I and -II randomized 1854 subjects at 211 sites in 16 countries. In the combined trials, all-cause mortality and the composite, first co-primary endpoint did not differ between the two treatment groups [hazard ratio (HR) 0.97; 95% confidence interval (CI) 0.80–1.17; and HR 0.98; 95% CI 0.86–1.12, respectively, for enoximone vs. placebo]. The two other co-primary endpoints were analysed separately in the two ESSENTIAL trials, as prospectively designed in the protocol. The 6MWTD increased with enoximone, compared with placebo, in ESSENTIAL-I (P = 0.025, not reaching, however, the pre

  2. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Rujic, Dragana; Sundbøll, Jens; Tofig, Bawer Jalal;

    2016-01-01

    The paroxysmal supraventricular tachycardias (SVT) are commonly encountered arrhythmias and include atrioventricular nodal re-entrant tachycardia, atrioventricular reciprocating tachycardia, and focal atrial tachycardia. These tachycardias share several clinical features as well as similar manage...

  3. Neglecting human ecology: The common element of global health failures

    Science.gov (United States)

    Hanley, Matthew

    2016-01-01

    Attempts to control malaria, AIDS, and maternal mortality in Africa have been woefully inadequate. This has involved adopting an almost exclusively technical preventive approach in the context of AIDS even though emphasizing human behavior holds the most promise. But on the other hand, it has also involved abandoning highly effective technical measures, as in the case of malaria. This suggests that the failure, at root, is anthropological in nature. The common element, it is argued here, is the failure to place the human ecology resolutely above destructive ideologies. Sound public-health approaches have been spurned in favor of predetermined preventive approaches in the service of ideological aims rather than of man and the common good. This article examines the ideological forces that have ultimately driven global health policy, and proposes that a more humane anthropology would be beneficial. Lay Summary: The scourges of malaria, AIDS, and maternal mortality have persisted in Africa, even though sensible and available means of addressing these epidemics, when stressed, have met with success. The reluctance to consistently emphasize the soundest public-health approaches—whether technical or behavioral in nature—indicate that global health policy has to a large extent been improperly concerned with advancing ideological agendas. The challenge we face today is not primarily technical but philosophical; the healing professions would perform a service by cultivating a higher view of man and an appreciation for objective moral truths that protect him. PMID:27833184

  4. Anemia nos pacientes com insuficiência cardíaca avançada Anemia en los pacientes con insuficiencia cardíaca avanzada Anemia in patients with advanced heart failure

    Directory of Open Access Journals (Sweden)

    Juliano Cardoso

    2010-10-01

    Full Text Available FUNDAMENTO: Anemia está associada à pior evolução nos pacientes com insuficiência cardíaca (IC. Entretanto, há poucos estudos sobre a anemia nos pacientes com IC avançada. OBJETIVO: Avaliar as características da anemia na IC em fase avançada. MÉTODOS: Foram incluídos 99 pacientes hospitalizados para compensação de IC (CF IV/NYHA, com idade > 18 anos e FEVE 12 g/dl. A anemia foi marcador independente de mau prognóstico na análise multivariada (mortalidade 47% vs 24,6%, p = 0,016, risco relativo 2,54. CONCLUSÃO: Anemia acomete, aproximadamente, 1/3 dos pacientes com IC avançada, e a deficiência de ferro é uma importante etiologia. Pacientes anêmicos são mais idosos e apresentaram função renal mais deteriorada. A melhora da congestão não foi suficiente para melhorar a anemia na maioria dos casos. Nos pacientes com IC avançada, a anemia é marcador independente de mau prognóstico.FUNDAMENTO: Anemia está asociada a peor evolución en los pacientes con insuficiencia cardíaca (IC. Mientras tanto, hay pocos estudios sobre la anemia en los pacientes con IC avanzada. OBJETIVO: Evaluar las características de la anemia en la IC en fase avanzada. MÉTODOS: Fueron incluidos 99 pacientes hospitalizados para compensación de IC (CF IV/NYHA, con edad > 18 años y FEVI 12 g/dl. La anemia fue marcador independiente de mal pronóstico en el análisis multivariado (mortalidad 47% vs 24,6%, p = 0,016, riesgo relativo 2,54. CONCLUSIÓN: Anemia afecta, aproximadamente, 1/3 de los pacientes con IC avanzada, y la deficiencia de hierro es una importante etiología. Pacientes anémicos son más añosos y presentaron función renal más deteriorada. La mejora de la congestión no fue suficiente para mejorar la anemia en la mayoría de los casos. En los pacientes con IC avanzada, la anemia es marcador independiente de mal pronóstico.BACKGROUND: Anemia is linked with worsening of progress in patients with heart failure (HF. However, there are

  5. Forest management in Bolivia, Honduras and Nicaragua : reform failures?

    NARCIS (Netherlands)

    L. Pellegrini (Lorenzo)

    2009-01-01

    textabstractIn this study we contrast forestry reforms and their stated objectives against the state of the forestry sector in Bolivia, Honduras and Nicaragua. Once we look at the policy failures that underlie the gap between policy objectives and the state of forestry, we find that stated policies

  6. A prospective comparison of alginate-hydrogel with standard medical therapy to determine impact on functional capacity and clinical outcomes in patients with advanced heart failure (AUGMENT-HF trial).

    Science.gov (United States)

    Anker, Stefan D; Coats, Andrew J S; Cristian, Gabriel; Dragomir, Dinu; Pusineri, Enrico; Piredda, Massimo; Bettari, Luca; Dowling, Robert; Volterrani, Maurizio; Kirwan, Bridget-Anne; Filippatos, Gerasimos; Mas, Jean-Louis; Danchin, Nicolas; Solomon, Scott D; Lee, Randall J; Ahmann, Frank; Hinson, Andy; Sabbah, Hani N; Mann, Douglas L

    2015-09-07

    AUGMENT-HF was an international, multi-centre, prospective, randomized, controlled trial to evaluate the benefits and safety of a novel method of left ventricular (LV) modification with alginate-hydrogel. Alginate-hydrogel is an inert permanent implant that is directly injected into LV heart muscle and serves as a prosthetic scaffold to modify the shape and size of the dilated LV. Patients with advanced chronic heart failure (HF) were randomized (1 : 1) to alginate-hydrogel (n = 40) in combination with standard medical therapy or standard medical therapy alone (Control, n = 38). The primary endpoint of AUGMENT-HF was the change in peak VO2 from baseline to 6 months. Secondary endpoints included changes in 6-min walk test (6MWT) distance and New York Heart Association (NYHA) functional class, as well as assessments of procedural safety. Enrolled patients were 63 ± 10 years old, 74% in NYHA functional class III, had a LV ejection fraction of 26 ± 5% and a mean peak VO2 of 12.2 ± 1.8 mL/kg/min. Thirty-five patients were successfully treated with alginate-hydrogel injections through a limited left thoracotomy approach without device-related complications; the 30-day surgical mortality was 8.6% (3 deaths). Alginate-hydrogel treatment was associated with improved peak VO2 at 6 months-treatment effect vs. +1.24 mL/kg/min (95% confidence interval 0.26-2.23, P = 0.014). Also 6MWT distance and NYHA functional class improved in alginate-hydrogel-treated patients vs. Control (both P Alginate-hydrogel in addition to standard medical therapy for patients with advanced chronic HF was more effective than standard medical therapy alone for improving exercise capacity and symptoms. The results of AUGMENT-HF provide proof of concept for a pivotal trial. NCT01311791. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

  7. Interest mediation and policy formulation in the European Union. Influence of transnational technology-oriented agreements on European policy in the field of carbon capture and storage. Advances in systems analysis 3

    Energy Technology Data Exchange (ETDEWEB)

    Schenk, Olga

    2013-10-01

    The United Nations Framework Convention on Climate Change (UNFCCC) laid down the cornerstone in the international cooperation to reduce the greenhouse gas (GHG) emissions from fossil fuels combustion. The UNFCCC provided a general framework for global cooperation to mitigate climate change. The Kyoto Protocol to the UNFCCC which formulated binding GHG emissions reduction targets did not result in universal participation. The United States- the major CO{sub 2} emitting country at the time of the adoption of the Kyoto Protocol in 1997 - signed but did not ratify the Protocol. China - the current top CO{sub 2} emitter - does not belong to the list of countries which are committed to the CO{sub 2} reductions in the framework of the Protocol. Whereas the approach pursued within the UNFCCC is based on a goal-setting in the framework of the legally binding international treaties, an alternative approach to GHG mitigation presents a voluntary international cooperation in the field of development and deployment of innovative technologies. The technology-oriented approach to climate change mitigation led to the development of the specific forms of cooperation between the public authorities and the stakeholders. Previous research referred to the organizations aimed at the transnational cooperation in the field of development and deployment of innovative technologies to mitigate GHG emissions as the technology-oriented agreements (TOA). The literature on TOA focused on the scope of the contribution of the technology-oriented approach to the climate change mitigation targets. This PhD research project analyzes the influence of those specific forms of cooperation on policies in the field of development and deployment of innovative technologies. The principal research question of the research project is formulated as follows - What is the influence of the technology-oriented agreements on policies aimed at supporting innovative technologies for mitigation of GHG emissions? The

  8. Interest mediation and policy formulation in the European Union. Influence of transnational technology-oriented agreements on European policy in the field of carbon capture and storage. Advances in systems analysis 3

    Energy Technology Data Exchange (ETDEWEB)

    Schenk, Olga

    2013-10-01

    The United Nations Framework Convention on Climate Change (UNFCCC) laid down the cornerstone in the international cooperation to reduce the greenhouse gas (GHG) emissions from fossil fuels combustion. The UNFCCC provided a general framework for global cooperation to mitigate climate change. The Kyoto Protocol to the UNFCCC which formulated binding GHG emissions reduction targets did not result in universal participation. The United States- the major CO{sub 2} emitting country at the time of the adoption of the Kyoto Protocol in 1997 - signed but did not ratify the Protocol. China - the current top CO{sub 2} emitter - does not belong to the list of countries which are committed to the CO{sub 2} reductions in the framework of the Protocol. Whereas the approach pursued within the UNFCCC is based on a goal-setting in the framework of the legally binding international treaties, an alternative approach to GHG mitigation presents a voluntary international cooperation in the field of development and deployment of innovative technologies. The technology-oriented approach to climate change mitigation led to the development of the specific forms of cooperation between the public authorities and the stakeholders. Previous research referred to the organizations aimed at the transnational cooperation in the field of development and deployment of innovative technologies to mitigate GHG emissions as the technology-oriented agreements (TOA). The literature on TOA focused on the scope of the contribution of the technology-oriented approach to the climate change mitigation targets. This PhD research project analyzes the influence of those specific forms of cooperation on policies in the field of development and deployment of innovative technologies. The principal research question of the research project is formulated as follows - What is the influence of the technology-oriented agreements on policies aimed at supporting innovative technologies for mitigation of GHG emissions? The

  9. Respiratory failure

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930118 Facial or nasal mask pressure supportventilation in managing acute exacerbation ofchronic respiratory failure in COPD patients.CHEN Rongchang(陈荣昌),et al.GuangzhouInstit Respir Dis,Guangzhou 510120.Chin Tu-berc & Respir Dis 1992;15(5)285-287.Eleven COPD patients(age:65±9 yrs)withacute exacerbation of chronic respiratory failure(PaCO2 11.3±1.1kPa)were treated with maskpressure support ventilation,another 10 similarpatients(age:68±12yrs)served as controls.Bi-PAP ventilator was used with the followingmodifications:(1)Non-rehreathing valve set-in proximal to mask;(2)5 LPM oxygen flow de-livered into mask to reduce the dead space ef-fect.Mask ventilation was given 2-3 hours ev-ery time and 1-2 times daily for 7 days.Syn-

  10. Job-Linked Literacy: Innovative Strategies at Work. Part III. Moving Ahead: Basic Skills for Career Advancement. A Work in America Policy Study.

    Science.gov (United States)

    Rosow, Jerome M.; Zager, Robert

    This volume, Interim Report No. 3 in a 3-year study, considers literacy programs designed to qualify employees for promotions or professional advancement. It adopts a multidimensional definition of moving ahead, one that extends to monetary rewards, career development, and employment security. The volume is divided into two parts: report and case…

  11. Charter of the Science and Technology Policy Council (STPC)

    Science.gov (United States)

    The EPA Science and Technology Policy Council (STPC) will identify critical science and technology policy issues and develop policies to help advance the Administrator's environmental and public health priorities.

  12. L’échec de la réforme de la politique d’immigration de l’administration Bush The Failure of the Bush Administration’s Attempts at Reforming American Immigration Policy

    Directory of Open Access Journals (Sweden)

    Laurence Gervais

    2010-03-01

    last 20 years recall the First Continental Congress concerned about the risks of attracting the “unwanted” and of creating a class of “dependent” people by granting land ownership to immigrants too easily. Today, it is impossible not to realize how much immigrants are part of the American economy, as consumers as well as workers. According to the 2000 Census, the number of foreign-born residents was 31.1 million out of a total of 281.4 million. Under the Bush administration, 6 million individuals were arrested and deported. Some statistics mention around 12 million illegal immigrants, 7 million of them employed in the United States. If 9.11 changed things dramatically, introducing the fear of admitting potential terrorists amongst candidates for immigration to the United States, it is the multiplicity of actors in the debate that is partly responsible for the failure of the Bush administration’s attempts at reforming American immigration policy.

  13. When Regional Innovation Policies Meet Policy Rationales and Evidence

    DEFF Research Database (Denmark)

    Borrás, Susana; Jordana, Jacint

    2016-01-01

    In spite of recent advancements regarding regional innovation policy rationales and evidence, there are few analyses about the actual features of existing regional innovation policies. Nevertheless, a policy analysis perspective is important in order to recognize their distinctive patterns across...... regions, and to understand how rationales and evidence can be translated into policy-making. To this purpose, this paper develops a framework to study the extent to which regional innovation policies have changed during the past few years. Since the mid-2000s, there has been an important development...

  14. Innovating innovation Policy. Rethinking green innovation policy in evolutionary perspective

    NARCIS (Netherlands)

    Arentsen, Maarten J.; Dinica, V.; Marquart, N.E.

    1999-01-01

    Advanced environmental standards such as sustainability require substantial improvements in the environmental performances of present technologies. Governments are faced with the challenge to design green innovation policies able to support producers and users of technologies to comply with such

  15. Pediatric Heart Failure in the Developing World.

    Science.gov (United States)

    Ramakrishnan, Sivasubramanian

    2014-01-01

    The exact prevalence of heart failure among children of developing countries is not known, as the data is limited. The relative frequency of different causes of pediatric heart failure varies widely across different countries and even among different parts of large countries like India. Children of developing countries face a double burden of etiologies. Conditions such us congenital heart disease, myocarditis and cardiomyopathies are common causes of pediatric of heart failure. In addition, diseases like rheumatic heart disease, nutritional deficiencies, and other tropical diseases also result in heart failure among children of the developing countries. However, most of the developing countries have low resources and hence management of pediatric heart failure becomes challenging. Advanced therapies for heart failure are rarely used in children of developing countries and cardiac transplant remains a distant dream.

  16. Demonstration Advanced Avionics System (DAAS), Phase 1

    Science.gov (United States)

    Bailey, A. J.; Bailey, D. G.; Gaabo, R. J.; Lahn, T. G.; Larson, J. C.; Peterson, E. M.; Schuck, J. W.; Rodgers, D. L.; Wroblewski, K. A.

    1981-01-01

    Demonstration advanced anionics system (DAAS) function description, hardware description, operational evaluation, and failure mode and effects analysis (FMEA) are provided. Projected advanced avionics system (PAAS) description, reliability analysis, cost analysis, maintainability analysis, and modularity analysis are discussed.

  17. Informing and implementing policy to advance mental health and wellbeing through action research in a rural remote community mental health setting.

    Science.gov (United States)

    Petrie, Eileen; Schultz, Timothy; Pearson, Alan

    2009-08-01

    The aim of this study was to work collaboratively with a rural Community Mental Health Team (CMHT) to examine the issue of workplace stress and address issues specified by the group. A five stage action research method following the Susman and Evered Model of Change was implemented for this research with four distinct cycles completed. A cyclic process of action research established that organizational policies, clinical skills and educational levels of staff were inadequate. Two overarching themes drove the research cycles: staff safety and inadequate education of nursing staff to assess and appropriately manage consumers with mental health issues. This study found that unsafe environmental conditions in the health workplace and limited staff knowledge contributed to workplace stress. Staff identified as vital strategies to manage aggressive or potentially aggressive incidents effectively and ensure staff and client safety. Managers, policy makers and government officials need awareness of the threats to healthy workforces. Tools to guide practice and staff education were implemented to address the identified problems.

  18. Kidney (Renal) Failure

    Science.gov (United States)

    ... How is kidney failure treated? What is kidney (renal) failure? The kidneys are designed to maintain proper fluid ... marrow and strengthen the bones. The term kidney (renal) failure describes a situation in which the kidneys have ...

  19. Acute kidney failure

    Science.gov (United States)

    Kidney failure; Renal failure; Renal failure - acute; ARF; Kidney injury - acute ... There are many possible causes of kidney damage. They include: ... cholesterol (cholesterol emboli) Decreased blood flow due to very ...

  20. Living with Heart Failure

    Science.gov (United States)

    ... page from the NHLBI on Twitter. Living With Heart Failure Currently, heart failure has no cure. You'll ... avoid harmful side effects. Take Steps To Prevent Heart Failure From Getting Worse Certain actions can worsen your ...

  1. Classes of Heart Failure

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Classes of Heart Failure Updated:Sep 28,2016 Doctors usually classify patients' ... Blood Pressure Tracker Find additional helpful resources here Heart Failure • Home • About Heart Failure Introduction Types of Heart ...

  2. About Heart Failure

    Science.gov (United States)

    ... talk about your health and the medicines About Heart Failure Heart failure is a disease where the heart cannot do ... very important for your health. common causes of heart failure are diseases or conditions that damage the heart. ...

  3. What Is Heart Failure?

    Science.gov (United States)

    ... page from the NHLBI on Twitter. What Is Heart Failure? Heart failure is a condition in which the heart can' ... force. Some people have both problems. The term "heart failure" doesn't mean that your heart has stopped ...

  4. Acute Kidney Failure

    Science.gov (United States)

    ... out of balance. Acute kidney failure — also called acute renal failure or acute kidney injury — develops rapidly over ... 2015. Palevsky PM. Definition of acute kidney injury (acute renal failure). http://www.uptodate.com/home. Accessed April ...

  5. Avances en terapia insulínica en la diabetes mellitus tipo 1: Aciertos y desaciertos Advances in insulin-therapy in type 1 diabetes mellitus: Success and failures

    Directory of Open Access Journals (Sweden)

    Tania Mayvel Espinosa Reyes

    2007-04-01

    , and all this supported by new systems of glucose monitoring. In the pas decade, islet transplant and gen therapy with obtention of ß cells from pluripotential stem cells, increase expectation in this field. All these elements confirm the endless path in the search of efficaceous therapeutics in treatment of Type 1 diabetes mellitus. Aim of this paper is to expose main advances on the subject of insulin therapy and to think over sucess and failures in its introduction.

  6. Patterns of Failure in Advanced Stage Diffuse Large B-Cell Lymphoma Patients After Complete Response to R-CHOP Immunochemotherapy and the Emerging Role of Consolidative Radiation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Shi, Zheng [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Das, Satya; Okwan-Duodu, Derick [Emory University School of Medicine, Atlanta, Georgia (United States); Esiashvili, Natia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Flowers, Christopher [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Medical Oncology, Emory University, Atlanta, Georgia (United States); Chen, Zhengjia; Wang, Xiaojing [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia (United States); Jiang, Kun [Department of Pathology, Emory University, Atlanta, Georgia (United States); Nastoupil, Loretta J. [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Medical Oncology, Emory University, Atlanta, Georgia (United States); Khan, Mohammad K., E-mail: drkhurram2000@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2013-07-01

    Purpose: The role of consolidative radiation therapy (RT) after complete response (CR) to rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) for stage III-IV diffuse large B-cell lymphoma (DLBCL) patients is unclear. We aimed to evaluate our institutional experience when consolidative RT is delivered to initial presenting sites or bulky sites in these patients. Methods and Materials: We identified 211 histologically confirmed stage III-IV DLBCL patients who received R-CHOP from January 2000 to May 2012 at our institution. Patterns of failure for patients who achieved CR to R-CHOP were analyzed. Local control (LC), distant control (DC), progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan-Meier method and compared between patients who received R-CHOP alone versus R-CHOP plus consolidative RT using the log–rank test. Multivariate analyses were also performed using Cox proportional hazards model. Results: Detailed treatment records were available for 163 patients. After a median 6 cycles of R-CHOP, 110 patients (67.5%) achieved CR and were entered for analysis. Fourteen patients (12.7%) received consolidative RT. After median follow-up of 32.9 months, 43.8% of patients who received R-CHOP alone failed at the initial sites with or without distant recurrence (DR), whereas isolated DR only occurred in 3.7% of these patients. Consolidative RT was associated with significantly improved LC (91.7% vs 48.8%), DC (92.9% vs 71.9%), PFS (85.1% vs 44.2%), and OS (92.3% vs 68.5%; all Ps<.0001) at 5 years compared with patients with R-CHOP alone. On multivariate analysis, consolidative RT and nonbulky disease were predictive of increased LC and PFS, whereas bone marrow involvement was associated with increased risk of DR and worse OS. Consolidative RT was also associated with marginal improved OS. Conclusions: Forty-four percent of patients with advanced stage DLBCL failed at initial presenting sites after

  7. People and biodiversity policies: impacts, issues and strategies for policy action

    National Research Council Canada - National Science Library

    Bagnoli, Philip; Goeschl, Timo; Kovács, Eszter

    2008-01-01

    ... an important characteristic of policy, rather it is a central issue in the policy's success or failure. The lessons from the early examples of implemention will need to be learnt swiftly as new sets of policies are being designed to manage the pressures from agricultural expansion, population growth, infrastructure development and climate chan...

  8. 论二战时期日军对盟军高级战俘奉行政策之演变%Discuss the Evolution of Japanese Policy towards the Implementation of Advanced Allied War Prisoners During World War II

    Institute of Scientific and Technical Information of China (English)

    陈春萍

    2015-01-01

    二战时期,日军在进攻东南亚时,俘虏了大量美国、英国与荷兰的军政高级官员。这些高级战俘从1942年8月开始,从各自被关押地运送到台湾,最后又转押到中国东北。日军频繁变更盟军高级战俘的关押地,主要是太平洋战争局势的变化以及日本对待高级战俘政策变化的外在反映。本文即在探讨日本在各个时期对于高级战俘关押地的变化和待遇与日军太平洋战局的关系,以总结出二战时期日军对高级战俘们所奉行政策的演变过程。%During World War II, the Japanese army attacked Southeast Asia, captured a large number of Unit-ed States, Britain and the Netherlands military senior officials.From the beginning of August 1942, these senior prisoners were transported from their places to Taiwan, and finally transferred to northeast China, was the main re-flection of changes the situation in the Pacific War, and Japanese treatment of prisoners of war policy changes ad-vanced external.This article discussed the relationship between changes and treatment of the Japanese advanced prisoners of war in all period, and the situation of Japanese Pacific war during World War II to summarize the senior prisoner of War pursued the policy evolution.

  9. Atmospheric sciences transfer between research advances and energy-policy assessments (ASTRAEA). Final report, 1 April 1996--31 December 1997

    Energy Technology Data Exchange (ETDEWEB)

    Slinn, W.G.N.

    1997-12-10

    Consistent with the prime goal of the ASTRAEA project, as given in its peer-reviewed proposal, this final report is an informal report to DOE managers about a perceived DOE management problem, specifically, lack of vision in DOE`s Atmospheric Chemistry Program (ACP). After presenting a review of relevant, current literature, the author suggests a framework for conceiving new visions for ACP, namely, multidisciplinary research for energy policy, tackling tough (e.g., nonlinear) problems as a team, ahead of political curves. Two example visions for ACP are then described, called herein the CITIES Project (the Comprehensive Inventory of Trace Inhalants from Energy Sources Project) and the OCEAN Project (the Ocean-Circulation Energy-Aerosol Nonlinearities Project). Finally, the author suggests methods for DOE to provide ACP with needed vision.

  10. Security and policy driven computing

    CERN Document Server

    Liu, Lei

    2010-01-01

    Security and Policy Driven Computing covers recent advances in security, storage, parallelization, and computing as well as applications. The author incorporates a wealth of analysis, including studies on intrusion detection and key management, computer storage policy, and transactional management.The book first describes multiple variables and index structure derivation for high dimensional data distribution and applies numeric methods to proposed search methods. It also focuses on discovering relations, logic, and knowledge for policy management. To manage performance, the text discusses con

  11. An Analytical Framework for Performance of Different Fault Restoration Policies with QoS Constraints in MPLS Networks

    Institute of Scientific and Technical Information of China (English)

    Xian-Si Tan; Zong-Kai Yang; Liang Ou; Jing-Wen Chen; Ya-Jie Ma

    2004-01-01

    An analytical framework for the performance of different protection switching restoration mechanisms with different protection policies in Multi-Protocol Label Switching (MPLS) networks is developed, where the protection policy may be 1 + 1, 1:1, n:l or n:m. As a general rule, it aims at the MPLS networks with the protection paths created in advance of fault occurrence without resources reserved, and it reroutes the protected traffic in the event of link or router failures while trying to maintain quality of service (QoS) requirements. Based on the proposed protocol for processing faults, an analytical model and an evaluating model are created, and the benefits and penalties of different mechanisms with different protection policies are evaluated. In particular, an improvement on the proposed protocol is presented to overcome the drawbacks of n:m protection policy in which m > 1 and n> 1.

  12. Supply chain inventory and pricing policy based on advance payment discount%提前支付折扣条件下供应链库存与定价策略

    Institute of Scientific and Technical Information of China (English)

    叶国雨

    2015-01-01

    延期支付信用时的库存策略得到了较多的关注,然而对提前支付信用条件下的库存策略研究较少。针对这一不足,研究了需求随机时,在单个供应商和单个零售商组成的供应链中,当供应商的对零售商提前支付给予价格折扣优惠时,零售商的最优采购策略和供应商的最优折扣策略。零售商在给定价格折扣时,确定最优的提前采购批量和总的采购批量,而供应商则根据零售商对价格折扣的反应设定最优的价格折扣策略。数值算例验证了论文的结论。%Inventory policy under delay payment has gained much attention.However, little literature is about inventory policy under advance payment.This paper dealt with the prob-lem of determining the retailer ’ s optimal ordering policy and supplier ’ s optimal cash dis-count under the conditions of stochastic demand and a single-supplier, a single-retailer supply chain.Given the cash discount rate, retailer decides the optimal total order size and advance payment order size.The supplier decided the optimal cash discount rate according to retailer’ s reflecting.Mathematical models have been derived for obtaining the optimal total and early payment quantity for retailer and optimal cash discount rate for supplier.The nu-merical examples are given to illustrate the results in the paper.

  13. Types of Heart Failure

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Types of Heart Failure Updated:Feb 9,2017 Left-sided heart failure ... making. This content was last reviewed April 2015. Heart Failure • Home • About Heart Failure Introduction Types of Heart ...

  14. Advancing system and policy changes for social and racial justice: comparing a Rural and Urban Community-Based Participatory Research Partnership in the U.S.

    Science.gov (United States)

    Devia, Carlos; Baker, Elizabeth A; Sanchez-Youngman, Shannon; Barnidge, Ellen; Golub, Maxine; Motton, Freda; Muhammad, Michael; Ruddock, Charmaine; Vicuña, Belinda; Wallerstein, Nina

    2017-02-21

    The paper examines the role of community-based participatory research (CBPR) within the context of social justice literature and practice. Two CBPR case studies addressing health inequities related to Type 2 Diabetes and Cardiovascular disease were selected from a national cross-site study assessing effective academic-community research partnerships. One CBPR partnership works with African Americans in rural Pemiscot County, Missouri and the other CBPR partnership works with African American and Latinos in urban South Bronx, New York City. Data collection included semi-structured key informant interviews and focus groups. Analysis focused on partnerships' context/history and their use of multiple justice-oriented strategies to achieve systemic and policy changes in order to address social determinants of health in their communities. Community context and history shaped each partnership's strategies to address social determinants. Four social justice approaches (identity/recognition, procedural, distributive, and structural justice) used by both partnerships were identified. These social justice approaches were employed to address underlying causes of inequitable distribution of resources and power structures, while remaining within a scientific research framework. CBPR can bridge the role of science with civic engagement and political participation, empowering community members to become political agents who integrate evidence into their social justice organizing strategies.

  15. LTE-A载波聚合中的载波接入和切换管理策略研究%Carrier Access and Handover Management Policy of Carrier Aggregation in LTE-Advanced

    Institute of Scientific and Technical Information of China (English)

    魏立尧; 于翠波; 勾学荣

    2013-01-01

    It introduces several selection policies of primary component carrier access, and mobility management methods for different request of RRC signaling overhand. It contrasts the performance from different aspects such as CA scenarios, mobility speed, measurement period, and shows the comparison result of total handover number, handover failure rate, RRC reconfiguration.%提出了几种主频点接入的选择策略,以及不同RRC信令开销的频点切换管理方法。通过理论分析结合系统级动态仿真,对提出的策略和方法进行了比较。从不同的载波聚合场景、用户移动速度、频点测量周期等方面研究分析了切换次数、切换失败率、RRC重配置数量等性能。

  16. Understanding chronic heart failure

    OpenAIRE

    Fenton, Matthew; Burch, Michael

    2007-01-01

    The key principles of chronic heart failure and the development of clinical management strategies are described. The physiological changes in chronic heart failure and the clinical management of children with heart failure are considered, but the treatment of heart failure related to congenital heart disease or the intensive care management of heart failure are not mentioned as both topics require consideration in their own right. A greater understanding of the maladaptive responses to chroni...

  17. Immune mediated liver failure

    OpenAIRE

    Wang, Xiaojing; Ning, Qin

    2014-01-01

    Liver failure is a clinical syndrome of various etiologies, manifesting as jaundice, encephalopathy, coagulopathy and circulatory dysfunction, which result in subsequent multiorgan failure. Clinically, liver failure is classified into four categories: acute, subacute, acute-on-chronic and chronic liver failure. Massive hepatocyte death is considered to be the core event in the development of liver failure, which occurs when the extent of hepatocyte death is beyond the liver regenerative capac...

  18. Understanding contraceptive failure

    OpenAIRE

    Trussell, James

    2009-01-01

    Contraceptive failure is a major source of unintended pregnancy. This chapter will review sources of data and measurement of contraceptive failure, summarize results from the literature on the risks of contraceptive failure during typical and perfect use for available methods of contraception, provide a tool for communicating risks of contraceptive failure to clients, examine determinants of contraceptive failure, and identify methodological pitfalls in the published literature.

  19. Focus on renal congestion in heart failure.

    Science.gov (United States)

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet

    2016-02-01

    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.

  20. Behind the Failure of Public Policy:A Perspective of Legitimacy%公共政策失效的背后:一个合法性视阈的探析

    Institute of Scientific and Technical Information of China (English)

    朱艳敏

    2014-01-01

    As an important dimension to maintain the orderly operation of public policy,legality not only affects the legitimacy and effectiveness of the government,but also the consequence of government policies.The legality of public policy involves the subjects,enforcement,and the objects.However,the non-market nature of the subjects,the split operation during enforcement,and the less effective participation of the objects tend to undermine the effect and even legality of public policies.Therefore,the legality of public policies should be improved,quality of the policy makers upgraded,the legal and supervision environment of policy enforcement be optimized,and citizen participation be cultivated and encouraged.%作为维持公共政策系统有序运作的重要维度,合法性的高低不仅影响政府治理的正当性和有效性,也对政策实际效果产生正负型的向度指引。其中,公共政策的合法性获取离不开对政策主体、政策执行、政策客体的探讨。然而,政策主体的“非市场缺陷”、政策执行的“分裂操作”、政策客体的“低水平参与”,成为引致公共政策合法性削弱乃至失效的三大痼疾。要提升公共政策的合法性,需提高政策主体的综合素质与工作能力,优化政策执行的法制环境与监督机制,拓展公民政治参与范围和意识的培育。

  1. Mechanical circulatory devices in acute heart failure.

    Science.gov (United States)

    Teuteberg, Jeffrey J; Chou, Josephine C

    2014-07-01

    Cardiogenic shock remains a leading cause of mortality despite advances in the treatment of myocardial infarction and advanced heart failure. Medical therapy can be inadequate, and patients may need mechanical circulatory support (MCS). The proper application of MCS requires knowledge of the underlying cause of acute heart failure, familiarity with the circulatory support devices, and the potential benefits and limitations of device therapy. This article describes the most commonly used temporary ventricular assist devices and their use in the various causes of cardiogenic shock.

  2. Angiotensin II vaccine promising for patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    CHEN Yang-xin; YAO You-jie; NIE Ru-qiong; ZHOU Shu-xian; WANG Jing-feng

    2009-01-01

    @@ Chronic heart failure (CHF), as the end-stage presentation of all kinds of heart diseases, is a major public health problem as well as a pressing public policy issue. There are more than 5 million patients diagnosed with CHF in USA alone and approximately 550 000 new cases appear per year. About 0.4%-2% of the European population is affected by symptomatic heart failure. Hence heart failure is the leading cause of hospitalization especially in older people around the world.

  3. Gerald L. Epstein, PhD: director, center for science, technology, and security policy, American Association for the Advancement of Science (AAAS). Interview by Madeline Drexler.

    Science.gov (United States)

    Epstein, Gerald L

    2009-12-01

    Over his entire career, Gerald Epstein has toiled at the nexus of science, technology, and security. From 2003 to 2009, he was Senior Fellow for Science and Security at the Center for Strategic and International Studies Homeland Security Program, where he worked on reducing biological weapons threats, improving national preparedness, and easing potential tensions between the scientific research and national security communities. Epstein came to CSIS from the Institute for Defense Analyses. From 1996 to 2001, he served in the White House Office of Science and Technology Policy. And from 1983 to 1989, and again from 1991 until its demise in 1995, Epstein worked at the Congressional Office of Technology Assessment, where he directed a study on the proliferation of weapons of mass destruction, alongside research on other global security topics. A recognized expert in biological risk reduction, Epstein was actually trained as a physicist, having received SB degrees in physics and electrical engineering from MIT, and a PhD in physics from the University of California at Berkeley. How, then, did he come to study the evolving threat from bioterrorism? "What compelled me about bioterrorism was that it was a stellar example of a topic that would lead to a train wreck between the scientific community and the security community unless they figured out how to work together," he said. "The distance between a laboratory and a very large consequence event is a lot shorter in biology than in any other field. I got into bioterrorism to help make sure that the security community doesn't get so scared of the science that it shuts it down, and that the science community isn't so oblivious of security concerns that it pays no attention to them." Epstein spoke on November 6, 2009, with contributing writer Madeline Drexler, author of Emerging Epidemics: The Menace of New Infections (Penguin, 2009), an updated version of an earlier volume. Drexler holds a visiting appointment at the

  4. Policy Problematization

    Science.gov (United States)

    Webb, P. Taylor

    2014-01-01

    This article places Michel Foucault's concept of "problematization" in relation to educational policy research. My goal is to examine a key assumption of policy related to "solving problems" through such technologies. I discuss the potential problematization has to alter conceptions of policy research; and, through this…

  5. Policy Problematization

    Science.gov (United States)

    Webb, P. Taylor

    2014-01-01

    This article places Michel Foucault's concept of "problematization" in relation to educational policy research. My goal is to examine a key assumption of policy related to "solving problems" through such technologies. I discuss the potential problematization has to alter conceptions of policy research; and, through this…

  6. Failure rate analysis using GLIMMIX

    Energy Technology Data Exchange (ETDEWEB)

    Moore, L.M.; Hemphill, G.M.; Martz, H.F.

    1998-12-01

    This paper illustrates use of a recently developed SAS macro, GLIMMIX, for implementing an analysis suggested by Wolfinger and O`Connell (1993) in modeling failure count data with random as well as fixed factor effects. Interest in this software tool arose from consideration of modernizing the Failure Rate Analysis Code (FRAC), developed at Los Alamos National Laboratory in the early 1980`s by Martz, Beckman and McInteer (1982). FRAC is a FORTRAN program developed to analyze Poisson distributed failure count data as a log-linear model, possibly with random as well as fixed effects. These statistical modeling assumptions are a special case of generalized linear mixed models, identified as GLMM in the current statistics literature. In the nearly 15 years since FRAC was developed, there have been considerable advances in computing capability, statistical methodology and available statistical software tools allowing worthwhile consideration of the tasks of modernizing FRAC. In this paper, the approaches to GLMM estimation implemented in GLIMMIX and in FRAC are described and a comparison of results for the two approaches is made with data on catastrophic time-dependent pump failures from a report by Martz and Whiteman (1984). Additionally, statistical and graphical model diagnostics are suggested and illustrated with the GLIMMIX analysis results.

  7. Chief nursing officers’ perspectives on Medicare’s hospital-acquired conditions non-payment policy: implications for policy design and implementation

    Directory of Open Access Journals (Sweden)

    Wald Heidi

    2012-08-01

    Full Text Available Abstract Background Preventable adverse events from hospital care are a common patient safety problem, often resulting in medical complications and additional costs. In 2008, Center for Medicare and Medicaid Services (CMS implemented a policy, mandated by the Deficit Reduction Act of 2005, targeting a list of these ‘reasonably’ preventable hospital-acquired conditions (HACs for reduced reimbursement. Extensive debate ensued about the potential adverse effects of the policy, but there was little discussion of its impact on hospitals’ quality improvement (QI activities. This study’s goals were to understand organizational responses to the HAC policy, including internal and external influences that moderated the success or failure of QI efforts. Methods We employed a qualitative descriptive design. Representatives from 14 Nurses Improving Care of Health System Elders (NICHE hospitals participated in semi-structured interviews addressing the impact of the HAC policy generally, and for two indicator conditions: central-line associated bloodstream infection (CLABSI and catheter-associated urinary tract infection (CAUTI. Within-case analysis identified the key components of each institution’s response to the policy; across-case analysis identified themes. Exemplar cases were used to explicate findings. Results Interviewees reported that the HAC policy is one of many internal and external factors motivating hospitals to address HACs. They agreed the policy focused attention on prevention of HACs that had previously received fewer dedicated resources. The impact of the policy on prevention activities, barriers, and facilitators was condition-specific. CLABSI efforts were in place prior to the policy, whereas CAUTI efforts were less mature. Nearly all respondents noted that pressure ulcer detection and documentation became a larger focus stemming from the policy change. A major challenge was the determination of which conditions were

  8. Incremental Prognostic Power of Novel Biomarkers (Growth-Differentiation Factor-15, High-Sensitivity C-Reactive Protein, Galectin-3, and High-Sensitivity Troponin-T) in Patients With Advanced Chronic Heart Failure

    NARCIS (Netherlands)

    Lok, Dirk J.; Klip, IJsbrand T.; Lok, Sjoukje I.; de la Porte, Pieta W. Bruggink-Andre; Badings, Erik; van Wijngaarden, Jan; Voors, Adriaan A.; de Boer, Rudolf A.; van Veldhuisen, Dirk J.; van der Meer, Peter

    2013-01-01

    Elevated natriuretic peptides provide strong prognostic information in patients with heart failure (HF). The role of novel biomarkers in HF needs to be established. Our objective was to evaluate the prognostic power of novel biomarkers, incremental to the N-terminal portion of the natriuretic peptid

  9. The Nabucco project's economic failure - Lessons for the European Union's foreign gas policy; L'echec economique du projet Nabucco. Lecons pour la politique gaziere etrangere de l'Union Europeenne

    Energy Technology Data Exchange (ETDEWEB)

    Finon, D. [CNRS, Centre International de Recherche sur l' Environnement et de Developpement - CIRED-CNRS, 94 - Nogent-sur-Marne (France)

    2010-11-15

    This article criticises the new strategy of the European Union's foreign gas policy. The new policy translates in the setting up of gas corridors to diversify importations in a context of increased political competition with Russia. The inherent limitations of the EU's plan to promote the Nabucco gas pipeline as merchant line without seeking exporter involvement in the project are analysed. Such limitations are analysed through various economic prospects. A micro-economic calculation shows the significance of the use rate of a gas pipeline for profitability. The competition theory shows the possibility for an existing dominating firm to compete with a newcomer's investment by building equipment likely to pre-empt access to the resources. The transaction cost saving shows how long term undertakings between producers and suppliers are necessary for the development of transit infrastructures and distant gas fields. The article ends with the need for economic relevance in the EU's gas policy actions. (author)

  10. When Regional Innovation Policies Meet Policy Rationales and Evidence:

    DEFF Research Database (Denmark)

    Borrás, Susana; Jordana, Jacint

    In spite of recent advancements regarding regional innovation policy rationales and evidence, there are few analyses about the actual features of existing regional innovation policies. Nevertheless, a policy analysis perspective is important in order to recognise their distinctive patterns across...... regions, and to understand how rationales and evidence can be translated into policy-making. To this purpose, this paper develops a framework to study the extent to which regional innovation policies have changed during the past few years. Since the mid-2000s there has been an important development...... of innovation policy rationales, advocating for more specialisation; likewise, greater data availability at the regional level has allowed more sophisticated assessment of innovation performance. Finally, the crisis since 2008 has had ravaging effects in some regions, with job losses and severe economic...

  11. [Understanding heart failure].

    Science.gov (United States)

    Boo, José Fernando Guadalajara

    2006-01-01

    Heart failure is a disease with several definitions. The term "heart failure" is used by has brougth about confusion in the terminology. For this reason, the value of the ejection fraction (< 0.40 or < 0.35) is used in most meganalyses on the treatment of heart failure, avoiding the term "heart failure" that is a confounding concept. In this paper we carefully analyze the meaning of contractility, ventricular function or performance, preload, afterload, heart failure, compensation mechanisms in heart failure, myocardial oxygen consumption, inadequate, adequate and inappropriate hypertrophy, systole, diastole, compliance, problems of relaxation, and diastolic dysfunction. Their definitions are supported by the original scientific descriptions in an attempt to clarify the concepts about ventricular function and heart failure and, in this way, use the same scientific language about the meaning of ventricular function, heart failure, and diastolic dysfunction.

  12. Real System Failures

    Data.gov (United States)

    National Aeronautics and Space Administration — This resource area contains descriptions of actual electronic systems failure scenarios with an emphasis on the diversity of failure modes and effects that can...

  13. Contraceptive failure in China.

    Science.gov (United States)

    Wang, Duolao

    2002-09-01

    This study examines patterns and differentials of contraceptive failure rates by method and characteristics of users, using the Chinese Two-per-Thousand Fertility Survey data. The results show that contraceptive failure rates for modern methods including sterilization are some of the highest in the world. The first year failure rates are 4.2% for male sterilization, 0.7% for female sterilization, 10.3% for IUD, 14.5% for pill, and 19.0% for condom. There are also some differentials in contraceptive failure rates by users' sociodemographic and fertility characteristics. Contraceptive failure rate declines with women's age for all reversible methods. Rural women have higher sterilization, IUD, and condom contraceptive failure rates than urban women. Women with two or more children have a higher failure rate for sterilization methods but have lower failure rates for other methods.

  14. Fusion, cold fusion, and space policy

    Energy Technology Data Exchange (ETDEWEB)

    Rotegard, D. (CST Ltd. (United States))

    1991-01-01

    This paper critiques Americal science policy through a consideration of two examples-cold fusion and asteroid mining. It points out that the failure of central planning in science and technology policy is just as marked as in more mundane activities. It highlights the current low level of debate and points out some technical issues that need to be addressed. It concludes with evidence that the alliance of flawed policy options is further lowering the level of debate. (author).

  15. Acute liver failure

    DEFF Research Database (Denmark)

    Larsen, Fin Stolze; Bjerring, Peter Nissen

    2011-01-01

    Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these.......Acute liver failure (ALF) results in a multitude of serious complications that often lead to multi-organ failure. This brief review focuses on the pathophysiological processes in ALF and how to manage these....

  16. Energy Efficiency Policy and Carbon Pricing

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-07-01

    The main message of this paper is that while carbon pricing is a prerequisite for least-cost carbon mitigation strategies, carbon pricing is not enough to overcome all the barriers to cost-effective energy efficiency actions. Energy efficiency policy should be designed carefully for each sector to ensure optimal outcomes for a combination of economic, social and climate change goals. This paper aims to examine the justification for specific energy efficiency policies in economies with carbon pricing in place. The paper begins with an inventory of existing market failures that attempt to explain the limited uptake of energy efficiency. These market failures are investigated to see which can be overcome by carbon pricing in two subsectors -- electricity use in residential appliances and heating energy use in buildings. This analysis finds that carbon pricing addresses energy efficiency market failures such as externalities and imperfect energy markets. However, several market and behavioural failures in the two subsectors are identified that appear not to be addressed by carbon pricing. These include: imperfect information; principal-agent problems; and behavioural failures. In this analysis, the policies that address these market failures are identified as complementary to carbon pricing and their level of interaction with carbon pricing policies is relatively positive. These policies should be implemented when they can improve energy efficiency effectively and efficiently (and achieve other national goals such as improving socio-economic efficiency).

  17. Energy efficieny policy and carbon pricing

    Energy Technology Data Exchange (ETDEWEB)

    Ryan, Lisa; Moarif, Sara; Levina, Ellina; Baron, Richard

    2011-08-15

    The main message of this paper is that while carbon pricing is a prerequisite for least-cost carbon mitigation strategies, carbon pricing is not enough to overcome all the barriers to cost-effective energy efficiency actions. Energy efficiency policy should be designed carefully for each sector to ensure optimal outcomes for a combination of economic, social and climate change goals. This paper aims to examine the justification for specific energy efficiency policies in economies with carbon pricing in place. The paper begins with an inventory of existing market failures that attempt to explain the limited uptake of energy efficiency. These market failures are investigated to see which can be overcome by carbon pricing in two subsectors -- electricity use in residential appliances and heating energy use in buildings. This analysis finds that carbon pricing addresses energy efficiency market failures such as externalities and imperfect energy markets. However, several market and behavioural failures in the two subsectors are identified that appear not to be addressed by carbon pricing. These include: imperfect information; principal-agent problems; and behavioural failures. In this analysis, the policies that address these market failures are identified as complementary to carbon pricing and their level of interaction with carbon pricing policies is relatively positive. These policies should be implemented when they can improve energy efficiency effectively and efficiently (and achieve other national goals such as improving socio-economic efficiency).

  18. Advanced composites technology

    Energy Technology Data Exchange (ETDEWEB)

    DeTeresa, S J; Groves, S E; Sanchez, R J

    1998-10-01

    The development of fiber composite components in next-generation munitions, such as sabots for kinetic energy penetrators and lightweight cases for advanced artillery projectiles, relies on design trade-off studies using validated computer code simulations. We are developing capabilities to determine the failure of advanced fiber composites under multiaxial stresses to critically evaluate three-dimensional failure models and develop new ones if necessary. The effects of superimposed hydrostatic pressure on failure of composites are being investigated using a high-pressure testing system that incorporates several unique features. Several improvements were made to the system this year, and we report on the first tests of both isotropic and fiber composite materials. The preliminary results indicate that pressure has little effect on longitudinal compression strength of unidirectional composites, but issues with obtaining reliable failures in these materials still remain to be resolved. The transverse compression strength was found to be significantly enhanced by pressure, and the trends observed for this property and the longitudinal strength are in agreement with recent models for failure of fiber composites.

  19. In Support of Failure

    Science.gov (United States)

    Carr, Allison

    2013-01-01

    In this essay, I propose a concerted effort to begin devising a theory and pedagogy of failure. I review the discourse of failure in Western culture as well as in composition pedagogy, ultimately suggesting that failure is not simply a judgement or indication of rank but is a relational, affect-bearing concept with tremendous relevance to…

  20. Detecting failure of climate predictions

    Science.gov (United States)

    Runge, Michael C.; Stroeve, Julienne C.; Barrett, Andrew P.; McDonald-Madden, Eve

    2016-09-01

    The practical consequences of climate change challenge society to formulate responses that are more suited to achieving long-term objectives, even if those responses have to be made in the face of uncertainty. Such a decision-analytic focus uses the products of climate science as probabilistic predictions about the effects of management policies. Here we present methods to detect when climate predictions are failing to capture the system dynamics. For a single model, we measure goodness of fit based on the empirical distribution function, and define failure when the distribution of observed values significantly diverges from the modelled distribution. For a set of models, the same statistic can be used to provide relative weights for the individual models, and we define failure when there is no linear weighting of the ensemble models that produces a satisfactory match to the observations. Early detection of failure of a set of predictions is important for improving model predictions and the decisions based on them. We show that these methods would have detected a range shift in northern pintail 20 years before it was actually discovered, and are increasingly giving more weight to those climate models that forecast a September ice-free Arctic by 2055.

  1. Detecting failure of climate predictions

    Science.gov (United States)

    Runge, Michael C.; Stroeve, Julienne C.; Barrett, Andrew P.; McDonald-Madden, Eve

    2016-01-01

    The practical consequences of climate change challenge society to formulate responses that are more suited to achieving long-term objectives, even if those responses have to be made in the face of uncertainty1, 2. Such a decision-analytic focus uses the products of climate science as probabilistic predictions about the effects of management policies3. Here we present methods to detect when climate predictions are failing to capture the system dynamics. For a single model, we measure goodness of fit based on the empirical distribution function, and define failure when the distribution of observed values significantly diverges from the modelled distribution. For a set of models, the same statistic can be used to provide relative weights for the individual models, and we define failure when there is no linear weighting of the ensemble models that produces a satisfactory match to the observations. Early detection of failure of a set of predictions is important for improving model predictions and the decisions based on them. We show that these methods would have detected a range shift in northern pintail 20 years before it was actually discovered, and are increasingly giving more weight to those climate models that forecast a September ice-free Arctic by 2055.

  2. Policy Capacity Is Necessary but Not Sufficient; Comment on “Health Reform Requires Policy Capacity”

    Directory of Open Access Journals (Sweden)

    Sheldon Gen

    2015-12-01

    Full Text Available Policy capacity focuses on the managerial and organizational abilities to inform policy decisions with sound research and analysis, and facilitate policy implementation with operational efficiency. It stems from a view of the policy process that is rational and positivistic, in which optimal policy choices can be identified, selected, and implemented with objectivity. By itself, however, policy capacity neglects the political aspects of policy-making that can dominate the process, even in health policies. These technical capabilities are certainly needed to advance reforms in health policies, but they are not sufficient. Instead, they must be complemented with public engagement and policy advocacy to ensure support from the public that policies are meant to serve.

  3. Bone Marrow Failure Secondary to Cytokinesis Failure

    Science.gov (United States)

    2015-12-01

    have assessed the role of FA pathway in mitosis and confirmed that murine FA-deficient hematopoietic stem cells exhibit p53- mediated growth defects...results suggest that bone marrow failure in FA may be caused, in part, by p53- mediated cellular defects and underscore the importance of... mediated apoptosis of HSCs due to cytokinesis failure. The major goal of the project was to assess whether the p53- mediated apoptosis due to

  4. Docetaxel as salvage chemotherapy in patients with advanced non-small cell lung cancer after failure of cytotoxic agents and gefitinib treatment%晚期非小细胞肺癌化疗和靶向治疗失败后的挽救性化疗

    Institute of Scientific and Technical Information of China (English)

    Yilong Wu; Jinji Yang; Yujuan Huang; Qin Zhou; Yisheng Huang; Chongrui Xu

    2008-01-01

    Objective:We conducted a prospective phase Ⅱ trial of single-agent salvage chemotherapy with docetaxel in patients with advanced non-small cell lung cancer (NSCLC) after failure of chemotherapy and gefitinib to assess the efficacy and toxicity of docetaxel in this setting.Methods:Patients with histologically confirmed NSCLC who were failure of chemotherapy and gefitinib were given docetaxel 75 mg/m2 intravenously for 30 min every 3 weeks until the toxicity was unacceptable or disease progressed.The response evaluation criteria in solid tumors (RECIST) guidelines were used for the evaluation of antitumor activity.Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria version 2.0.Results:In total,31 patients were enrolled in this phase Ⅱ trial between February 2004 and December 2006,and 84 cycles (average 2.7 cycles) were given.We observed 4 partial responses (PRs) and 10 stable disease (SD) states in 31 eligible patients.The objective response rate was 12.9%,and the disease control rate was 45.2%.The median survival time (MST) was 10 months (95% Cl,5.05-15.08 months).The 1-year survival rate was 40.6%.The most common toxicities were neutropenia,anemia,and peripheral neuropathy that occurred as follows:45% of the patients experienced grade 3 or 4 neutropenia,29% experienced grade 3 anemia,and 25.8% had grade 3 peripheral neuropathy.No patient terminated docetaxel chemotherapy due to toxicity.Conclusion:Docetaxei is beneficial as salvage chemotherapy in patients with advanced NSCLC after failure of cytotoxic agents and gefitinib.

  5. Survey of maintenance policies for the Last 50 Years

    Directory of Open Access Journals (Sweden)

    Asis Sarkar

    2011-08-01

    Full Text Available In the past several decades, maintenance and replacement problems have been extensively studied inthe literature. Thousands of maintenance and replacement models have been created. However, all thesemodels can fall into some categories of maintenance policies: age replacement policy, block replacementpolicy, periodic preventive maintenance policy, failure limit policy, sequential preventive maintenancepolicy, repair cost limit policy, repair time limit policy, repair number counting policy, reference timepolicy, mixed age policy, group maintenance policy, opportunistic maintenance policy, etc. Each kind ofpolicy has different characteristics, advantages and disadvantages with lot of contributions fromResearch scientist, Technologists... This survey summarizes, classifies, and compares various existingmaintenance policies Around 170 Authors and their research works are presented in the Referencesection. It will help to look into the different policies which is appropriate to the organization and forfurther study the reference section will be helpful for the researchers for further knowledge

  6. 卡培他滨在蒽环和紫杉类失败的晚期乳腺癌中疗效与安全性的分析%Analysis of the Efficacy and Safety of Capecitabine in Advanced Breast Cancer with Anthracycline and Taxane Failure

    Institute of Scientific and Technical Information of China (English)

    曾娟紫; 吴国武

    2013-01-01

      目的:探究卡培他滨在蒽环和紫杉类失败的晚期乳腺癌中的疗效与安全性。方法:选择20例蒽环和紫杉类失败的晚期乳腺癌患者,给予卡培他滨治疗,观察临床疗效及用药安全。结果:结束化疗4周后 ORR 率为25%,5例 PR 患者均接受蒽环和紫杉类单纯使用或联合使用方案治疗。主要药物不良反应有手足综合征、食欲不振、恶心、呕吐、便秘、中性粒细胞减少,且大部分为1~2级,3~4级毒性发病率较低。结论:卡培他滨在蒽环和紫杉类失败的晚期乳腺癌患者中疗效确切,且用药较安全,口服用药方便,成为晚期乳腺癌首选药物。%Objective:To explore efficacy and safety of capecitabine in advanced breast cancer with anthracycline and taxane failure.Method:20 patients with anthracycline and taxane failure in patients with advanced breast cancer,capecitabine,to observe the clinical efficacy and drug safety. Result:4 weeks after the end of chemotherapy,the ORR was 25%,five cases of PR patients underwent anthracycline and taxane simple to use or joint use regimen.The main adverse drug reactions hand-foot syndrome,loss of appetite,nausea,vomiting,constipation,neutropenia,and most of 1 to 2,3 to 4 toxicity incidence is relatively low.Conclusion:The exact efficacy of capecitabine in anthracycline and taxane failure in patients with advanced breast cancer,and the drug is safer,convenient oral medication,the drug of choice for advanced breast cancer.

  7. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of

  8. Optimized cardiac resynchronization therapy in patients with congestive heart failure

    Institute of Scientific and Technical Information of China (English)

    NIU Hong-xia; HUA Wei; ZHANG Shu; SUN Xin; CHEN Ke-ping; WANG Fang-zheng; CHEN Xin

    2007-01-01

    @@ Heart failure was a major and increasing public health problem, with an almost "epidemic increase in the number of patients.1 Despite recent advances in pharmacotherapy, the prognosis remains poor. Cardiac resynchronization therapy (CRT), by pacing right and left ventricles, has been proved to improve symptoms and reduce mortality for heart failure patients with cardiac dyssynchrony.

  9. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    2008-01-01

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of an

  10. Monetary Policy and Economic Policy

    Directory of Open Access Journals (Sweden)

    Iordachioaia Adelina-Geanina

    2011-02-01

    Full Text Available There is widespread agreement that monetary policy matters,but there is disagreement about how it should be conducted. Behind this disagreement lie differences in theoretical understandings. The paper contrasts the New Classical, Neo-Keynesian, and Post-Keynesian frameworks, there by surfacing the differences. The New Classical model has policy only affecting long run inflation. The Neo-Keynesian has policy impacting inflation, unemployment, and real wages. The Post-Keynesian model also impacts growth, so policy implicitly picks a quadruple. Inflation targeting is a sub-optimal policy frame because it biases decisions toward low inflation by obscuring the fact that policy also affects unemployment, real wages, and growth.

  11. Policy Innovation in Innovation Policy

    DEFF Research Database (Denmark)

    Borras, Susana

    as with national and sub-national governments in Europe, all of them introducing interesting novelties in their innovation policy. These changes refer to different aspects of policy, mainly the content of policy initiatives towards science, technology and innovation; the instruments governments are using...... to achieve their goals; and the actors in the policy system that are being mobilised in pursuing these goals. This paper deals with these policy changes, paying special attention to the novelties introduced since the early 1990s in Europe. The perspective of this paper deals mainly on the changes introduced...... at the EU level, and mentions similar trends taking place at national and sub-national levels. The questions that guide the contents here are essentially three, namely, what are the main traits of innovation policies in Europe since the 1990s and how have the EU and different national governments approached...

  12. Managing Feelings about Heart Failure

    Science.gov (United States)

    ... About Heart Failure Module 6: Managing Feelings About Heart Failure Download Module Order Hardcopy Heart failure can cause ... professional help for emotional problems. Common Feelings About Heart Failure It is common for people to feel depressed ...

  13. Failure During Sheared Edge Stretching

    Science.gov (United States)

    Levy, B. S.; van Tyne, C. J.

    2008-12-01

    Failure during sheared edge stretching of sheet steels is a serious concern, especially in advanced high-strength steel (AHSS) grades. The shearing process produces a shear face and a zone of deformation behind the shear face, which is the shear-affected zone (SAZ). A failure during sheared edge stretching depends on prior deformation in the sheet, the shearing process, and the subsequent strain path in the SAZ during stretching. Data from laboratory hole expansion tests and hole extrusion tests for multiple lots of fourteen grades of steel were analyzed. The forming limit curve (FLC), regression equations, measurement uncertainty calculations, and difference calculations were used in the analyses. From these analyses, an assessment of the primary factors that contribute to the fracture during sheared edge stretching was made. It was found that the forming limit strain with consideration of strain path in the SAZ is a major factor that contributes to the failure of a sheared edge during stretching. Although metallurgical factors are important, they appear to play a somewhat lesser role.

  14. Turkey's Educational Policies in Central Asia and Caucasia: Perceptions of Policy Makers and Experts

    Science.gov (United States)

    Akcali, Pinar; Engin-Demir, Cennet

    2012-01-01

    The purpose of this study is to analyze the educational policies of Turkey in Central Asia and Caucasia in the post-Soviet era in terms of their successes and failures as perceived by some of the relevant professional policy makers in this field as well as experts from various think-tank institutions in Turkey who are interested in the region.…

  15. Chronic heart failure part 2: treatment and management.

    Science.gov (United States)

    Brake, Rebecca; Jones, Ian David

    2017-01-11

    Chronic heart failure is a common and complex clinical syndrome that results from impaired cardiac relaxation or contraction. There have been considerable advances in the management of chronic heart failure; however, the mortality rate remains high. Patients with chronic heart failure may experience multiple debilitating symptoms, such as fatigue, pain, and peripheral oedema. However, breathlessness may be considered the most debilitating symptom. The management of chronic heart failure aims to improve the patient's quality of life by reducing symptoms and supporting the patient to manage their condition. Treatment of patients with chronic heart failure may involve a combination of pharmacological therapy, device implantation and cardiac rehabilitation. This is the second of two articles on chronic heart failure. Part 1 discussed the pathophysiology of chronic heart failure, its causes, assessment, signs and symptoms. Part 2 outlines the treatment and management of patients with the condition, including pharmacological strategies, device implantation, lifestyle modification, cardiac rehabilitation and palliative care.

  16. Policy Learning and Organizational Capacities in Innovation Policies

    DEFF Research Database (Denmark)

    Borrás, Susana

    2011-01-01

    Bengt-Åke Lundvall’s work has underlined the importance of policy learning for inducing innovation systems’ adaptability. In spite of his efforts and of the general interest in this topic, studies of policy learning in innovation policy continue to be scarce. Elaborating from recent theoretical a...... of science–industry relations, showing the importance of capacities (or lack thereof). This calls for the practical need of addressing organizational capacity-building, in particular of analytical capacity, for truly strategic innovation policy-making.......Bengt-Åke Lundvall’s work has underlined the importance of policy learning for inducing innovation systems’ adaptability. In spite of his efforts and of the general interest in this topic, studies of policy learning in innovation policy continue to be scarce. Elaborating from recent theoretical...... advances, the paper identifies three levels of policy learning and argues that their effects on innovation systems are related to specific capacities of the relevant organizations implementing change. This analytical framework is used in the study of trans-national policy learning in Europe in the area...

  17. Bituminous Pavement Failures

    Directory of Open Access Journals (Sweden)

    Surajo Abubakar Wada

    2016-02-01

    Full Text Available Pavement deterioration is a serious problem for road and traffic sector in almost every country, the most affecting causes of bituminous pavement failures have been studied in this paper. The paper describes the lessons learnt from pavement failures and problems experienced. Failures of bituminous pavements are caused due to many reasons or combination of reasons. Application of correction in the existing surface will enhance the life of maintenance works as well as that of strengthening layer. Along with the maintenance techniques there are various methods for pavement preservation which will help in enhancing the life of pavement and delaying of its failure.This paper discusses the possible causes of pavement failures, and recommendbetter ways to minimize and hopefully eliminate the causes of failures in bituminous pavements.

  18. Failure Analysis Handbook

    Science.gov (United States)

    1989-08-18

    47) described a method they called the "failure-experience matrix." This matrix was a three-dimensional array of cells , with failure modes along one...Russo, DFat ý , compiled by McDonnell-Dcuglas Astrovautics Cmpany, Huntington Beach, California, published by Metals and Ceramics Information Center...matrix." This matrix was a three dimensional array of cells , with failure modes along one axis, ryont "mechardcal function along a second axis and

  19. Failure to thrive.

    Science.gov (United States)

    Krugman, Scott D; Dubowitz, Howard

    2003-09-01

    Failure to thrive is a condition commonly seen by primary care physicians. Prompt diagnosis and intervention are important for preventing malnutrition and developmental sequelae. Medical and social factors often contribute to failure to thrive. Either extreme of parental attention (neglect or hypervigilance) can lead to failure to thrive. About 25 percent of normal infants will shift to a lower growth percentile in the first two years of life and then follow that percentile; this should not be diagnosed as failure to thrive. Infants with Down syndrome, intrauterine growth retardation, or premature birth follow different growth patterns than normal infants. Many infants with failure to thrive are not identified unless careful attention is paid to plotting growth parameters at routine checkups. A thorough history is the best guide to establishing the etiology of the failure to thrive and directing further evaluation and management. All children with failure to thrive need additional calories for catch-up growth (typically 150 percent of the caloric requirement for their expected, not actual, weight). Few need laboratory evaluation. Hospitalization is rarely required and is indicated only for severe failure to thrive and for those whose safety is a concern. A multidisciplinary approach is recommended when failure to thrive persists despite intervention or when it is severe.

  20. Science of science and innovation policy: principal investigators' conference summary

    National Research Council Canada - National Science Library

    Fealing, Kaye Husbands; Beatty, Alexandra S; Citro, Constance F

    2014-01-01

    .... The conference highlighted advances in the emerging field of the science of science and innovation policy, in particular, models, frameworks, tools, and datasets comprising the evidentiary basis...

  1. Young Adults Failure to Thrive Syndrome

    Directory of Open Access Journals (Sweden)

    Warren C. Sanderson

    2014-03-01

    Full Text Available Many young working age adults in developed countries are failing to thrive in economic, demographic and social terms. Their failure to thrive is a relatively new phenomenon that has not been widely recognized, but it affects young adults in virtually all the more developed countries for which we have relevant data. Young adults nowadays are more often in poverty. They are leaving their parental homes at ever later ages and in some countries the frequency of psychological problems increased. The seriousness of failure to thrive syndrome is reflected in the relationship between relative economic conditions and increased suicide rates. The syndrome is important because young adults are at the prime ages for finding employment, establishing long-run career paths and building an economic basis for founding a family. Developing strategies to arrest the spread of failure to thrive syndrome among young adults, in order to keep them vibrant contributors to our societies, should be a priority for policy makers.

  2. Policy stories

    DEFF Research Database (Denmark)

    Ren, Carina Bregnholm; Rasmussen, Rasmus Kjærgaard

    planning and execution and of event outcomes beyond the narrow confines of bed nights and legacies. Second, we introduce policies as an entry point to unlock discussions and manifestations of value and futures which connect to AWG. In order to exemplify the workings of the AWG event in these domains, we...... present three central policy stories from the field. The stories tell of how the event was first interested, then activated and finally evaluated. Besides adding a new understanding to policy-driven events as a locus of value creation, we also argue that the AWG 2016 offer speculative bets for new...

  3. El fracaso de la política económica para evitar la depresión de 1929-1932 The failure of monetary policy to prevent the depression of 1929-32

    Directory of Open Access Journals (Sweden)

    Uribe Helena

    1993-12-01

    Full Text Available Se acepta, generalmente, que la situación interna y externa en 1929 planteaba, respecto a la política monetaria, exigencias contradictorias. A juicio de Currie este punto de vista está equivocado. Tanto la situación internacional como la nacional exigían entonces el abandono de las restricciones monetarias, con lo cual, al mantenerse relativamente  estables los precios y el nivel de la actividad economía, se habrían evitado parcialmente las consecuencias de una recesión mundial. El argumento para mantener la restricción monetaria fue el auge de la  especulación. No obstante, no es claro que la especulación haya sido una causa importante de la recesión. De hecho, y en contra de la opinión generalizada que sostenía que los excesos del "boom" eran los    culpables de la gravedad de la recesión, el autor  demuestra que no hubo ni "boom" ni inflación durante los años veinte. Esta fue, más bien una época de estabilidad. Las deficiencias en la política monetaria, concluye el autor, tuvieron una gran responsabilidad en el origen de la crisis. Al concentrase prioritariamente en el freno a la especulación, se descuidó el análisis de conjunto sobre el nivel de actividad económica. Lejos de prevenir la recesión, se contribuyó con esto a desencadenarla.It is generally accepted that the internal and external situation in 1929 posed contradictory demands with respect to monetary policy. According to Currie this is an erroneous point of view. Both the international and national situations of that time demanded the withdLdwa1of monetary restrictions. This, along with the maintenance of relatively stable prices and level of economic activity, could have partially prevented the consequences of a world recession. The argument for maintaining the monetary restriction was the rise in speculation. Nevertheless, it is fl0t clear chat speculation harmed productive investment

  4. Retrospective survey of the efficacy of mandatory implementation of the Essential Medicine Policy in the primary healthcare setting in China: failure to promote the rational use of antibiotics in clinics.

    Science.gov (United States)

    Xiao, Yonghong; Wang, Jin; Shen, Ping; Zheng, Beiwen; Zheng, Yingdong; Li, Lanjuan

    2016-10-01

    The objective of this study was to understand the impact of implementation of the Essential Medicine Policy (EMP) on the rational use of antibiotics in primary medical institutions in China. A retrospective survey was conducted in 39 primary medical institutions to compare the efficacy of EMP in rational antibiotic use. All institutions completed the survey 1 year before and 1 year after implementation of the EMP. In particular, antibiotic use and its rationality were closely examined. The institutions mainly dealt with common diseases, especially non-infectious chronic diseases. Antibiotic usage was very inappropriate both before and after EMP implementation. Before and after EMP implementation, respectively, the median outpatient cost was US$6.34 and US$5.05, 52.50% (2005/3819) and 53.41% (1865/3492) of the outpatient prescriptions contained antibiotics, and 76.23% (1132/1485) and 78.83% (1106/1403) of inpatients were administered antibiotics. In addition, 98.38% (425/432) and 97.52% (512/525) of surgical inpatients were administered antibiotics, respectively, and 80.76% (638/790) and 75.19% (503/669) of patients with a cold were prescribed antibiotics, respectively. The most commonly used antibiotics were broad-spectrum and injectable agents, including cephalosporins, fluoroquinolones and penicillins. This profile showed little change following implementation of the EMP. In conclusion, inappropriate antibiotic use is a serious problem in primary medical institutions in China. Whilst enforcing the EMP reduced the cost of medical services, it had little effect on promoting the rational use of antibiotics.

  5. Transforming Policy into Justice

    Science.gov (United States)

    Gomes, Nadja; Maru, Vivek

    2016-01-01

    Abstract Despite expanding policy commitments in many poor countries, health care is often a failure at the point of delivery. Lack of information, poor enforcement, and power dynamics prevent those whose rights have been violated from pursuing redress. In Mozambique, grassroots health advocates work to address this gap between policy and reality by blending approaches known as legal empowerment and social accountability. They raise awareness of health policy, support clients to seek redress for grievances, and facilitate problem-solving dialogues between communities and health facility staff. In three years we have seen communities begin to overcome a culture of silence. Twenty-one advocates and their clients have achieved redress to over a thousand grievances across 27 health facilities. These cases have resulted in improvements to access, infrastructure, and provider performance. Advocates have supported village health committees to transform themselves from collections of names on a list into active agents for change. Advocates should not be trained and left alone—they are most effective when integrated into a vertical team that provides continuous support and supervision, and that can engage higher levels of authority to solve tough cases. Aggregate data from cases handled by health advocates provides unique insight into how health policy is working in practice. We draw on that information to advocate for systemic changes that affect the entire country, like better policies for combatting bribery and stronger procedures for responding to grievances. We have found that legal empowerment and social accountability practices interact synergistically. Our preliminary experience suggests that when people are equipped to exercise their rights to health, even a poorly resourced system can improve. PMID:28559689

  6. Intricacies in Drought Management Policy, Crisis Response and Preparedness: Linking the Interface

    Science.gov (United States)

    Prakash, P.; Harter, T.

    2016-12-01

    Drought per se is often misrepresented as mere water scarcity issue overlooking the complexities associated with it. In many parts of the world, the drought management policy prescriptions are often driven by crisis management rather than preventive approach. As a result, the economic, social and environmental impact of droughts continues to increase even to this day. To overcome this calamity, nations should encourage coordinated effort at both national and regional scale. An integrated approach on open data sharing, technical advancement in monitoring and robust early warning system to deliver timely information to decision makers, drought projection through high performance mathematical model and effective impact assessment procedure, implementing proactive risk management measures and preparedness with effective emergency response programs plans, will certainly increase the likelihood of drought coping capabilities. The present study focuses on knowledge augmentation for better policy framework and action for all countries that suffer from droughts. A comprehensive database at the global scale has been compiled giving information on existing drought management policies/practices and the major challenges faced by major drought distressed countries. Plausible solution is suggested towards integrating the water management policy, response and preparedness, that has been garnered through the lessons from success/failure stories of nations with effective drought management policies

  7. 7 CFR 1485.18 - Advances.

    Science.gov (United States)

    2010-01-01

    ... MARKETS FOR AGRICULTURAL COMMODITIES Market Access Program § 1485.18 Advances. (a) Policy. In general, CCC... to an MAP participant for brand promotion activities. (b) Exception. Upon request, CCC may advance payments to an MAP participant for generic promotion activities. Prior to making an advance, CCC...

  8. Chronic heart failure

    African Journals Online (AJOL)

    population, and up to 10% in people aged 75 years and older. It is also estimated that ... The first step in the development of heart failure is an injury to the myocardium ... treatment of heart failure by blocking the compensatory mechanisms with ... pulmonary disease, cognitive dysfunction, depression, chronic kidney disease ...

  9. Heart failure overview

    Science.gov (United States)

    ... symptoms) You feel a severe crushing chest pain Prevention Most cases of heart failure can be prevented by living a healthy lifestyle and taking steps aimed at reducing your risk for heart disease . . Alternative Names CHF; Congestive heart failure; Left-sided ...

  10. Essays on Environmental Economics and Policy

    Science.gov (United States)

    Walker, W. Reed

    A central feature of modern government is its role in designing welfare improving policies to address and correct market failures stemming from externalities and public goods. The rationale for most modern environmental regulations stems from the failure of markets to efficiently allocate goods and services. Yet, as with any policy, distributional effects are important there exist clear winners and losers. Despite the clear theoretical justification for environmental and energy policy, empirical work credibly identifying both the source and consequences of these externalities as well as the distributional effects of existing policies remains in its infancy. My dissertation focuses on the development of empirical methods to investigate the role of environmental and energy policy in addressing market failures as well as exploring the distributional implications of these policies. These questions are important not only as a justification for government intervention into markets but also for understanding how distributional consequences may shape the design and implementation of these policies. My dissertation investigates these questions in the context of programs and policies that are important in their own right. Chapters 1 and 2 of my dissertation explore the economic costs and distributional implications associated with the largest environmental regulatory program in the United States, the Clean Air Act. Chapters 3 and 4 examine the social costs of air pollution in the context of transportation externalities, showing how effective transportation policy has additional co-benefits in the form of environmental policy. My dissertation remains unified in both its subject matter and methodological approach -- using unique sources of data and sound research designs to understand important issues in environmental policy.

  11. EPIDURAL ANAESTHESIA FOR SURGERY IN ADVANCED CANCER

    African Journals Online (AJOL)

    Femi Olaleye

    Running title: Epidural Anaesthesia in Advanced Carcinoma. INTRODUCTION ... underlying muscle. His respiratory rate was ... Digoxin and management of congestive heart failure Omole M.K.. 2. ... the ventricle and suggests an elevated.

  12. [Palliative care in heart failure].

    Science.gov (United States)

    Gavazzi, Antonello; Svanoni, Fausto; De Maria, Renata

    2012-12-01

    The natural history of heart failure (HF) is characterized by a progressive decline in functional capacity, punctuated by acute heart destabilization episodes which contribute to a spiraling worsening course. Advanced HF affects one in four patients who are referred to the hospital for the syndrome and has an estimated yearly incidence of 12 000 new cases in Italy. Life expectancy is very limited, and in general less than 50% of advanced HF patients are alive at 1-2 years. Advanced HF patients show a high, not modifiable mortality, severe symptoms and impaired quality of life. Treatment goals should focus on the improvement of symptoms and quality of life, the aims of palliative care. Palliative consultations during hospital admissions reduce the number of interventions and procedures in the last stages of life, the length of stay in the intensive care unit and general ward. HF patients who receive home palliative care are more likely to die at home, in accordance with their expressed will. The research project RF-MAR-2007-67955 aims to analyze, through a prospective observational registry, the palliative care needs of HF patients in Italy, to answer the gaps in knowledge on symptom changes during the terminal stages of the disease, on the quality of communication between healthcare professionals, patients and their families and caregivers' needs.

  13. Policy analysis of electricity demand flexibility

    DEFF Research Database (Denmark)

    Katz, Jonas

    include a clear commitment to develop an "intelligent" energy system that utilises the flexibility potential of the demand side, a coherent policy strategy covering all aspects of the flexibility challenge has not yet been defined. By use of economic models and concepts of policy analysis, this thesis...... failures in the classic economic sense or systemic failures founded in market design, rules and regulations. The analysis covers impacts of failures stemming from incomplete markets for flexibility and inappropriate regulation that distort the observed value or risks of demand flexibility. Furthermore......, it considers various types of transaction costs related to adopting a demand response contract (switching costs) and to activation (monitoring and decision costs). The thesis develops methods to quantify the impacts of these failures and applies them in relation to the Danish case. Switching costs...

  14. From policy implementation to business process management : Principles for creating flexibility and agility

    NARCIS (Netherlands)

    Gong, Y.; Janssen, M.

    2012-01-01

    Organizations are required to comply with changes in legislation and policy. Yet the implementation of new legislation is often expensive, can have long lead times and is prone to failure. The existing situation significantly constrains policy-making. To improve this, policy makers and policy execut

  15. From policy implementation to business process management : Principles for creating flexibility and agility

    NARCIS (Netherlands)

    Gong, Y.; Janssen, M.

    2012-01-01

    Organizations are required to comply with changes in legislation and policy. Yet the implementation of new legislation is often expensive, can have long lead times and is prone to failure. The existing situation significantly constrains policy-making. To improve this, policy makers and policy

  16. An advanced joint inversion system for CO2 storage modeling with large date sets for characterization and real-time monitoring-enhancing storage performance and reducing failure risks under uncertainties

    Energy Technology Data Exchange (ETDEWEB)

    Kitanidis, Peter [Stanford Univ., CA (United States)

    2016-04-30

    As large-scale, commercial storage projects become operational, the problem of utilizing information from diverse sources becomes more critically important. In this project, we developed, tested, and applied an advanced joint data inversion system for CO2 storage modeling with large data sets for use in site characterization and real-time monitoring. Emphasis was on the development of advanced and efficient computational algorithms for joint inversion of hydro-geophysical data, coupled with state-of-the-art forward process simulations. The developed system consists of (1) inversion tools using characterization data, such as 3D seismic survey (amplitude images), borehole log and core data, as well as hydraulic, tracer and thermal tests before CO2 injection, (2) joint inversion tools for updating the geologic model with the distribution of rock properties, thus reducing uncertainty, using hydro-geophysical monitoring data, and (3) highly efficient algorithms for directly solving the dense or sparse linear algebra systems derived from the joint inversion. The system combines methods from stochastic analysis, fast linear algebra, and high performance computing. The developed joint inversion tools have been tested through synthetic CO2 storage examples.

  17. Predicting Failure Under Laboratory Conditions: Learning the Physics of Slow Frictional Slip and Dynamic Failure

    Science.gov (United States)

    Rouet-Leduc, B.; Hulbert, C.; Riviere, J.; Lubbers, N.; Barros, K.; Marone, C.; Johnson, P. A.

    2016-12-01

    Forecasting failure is a primary goal in diverse domains that include earthquake physics, materials science, nondestructive evaluation of materials and other engineering applications. Due to the highly complex physics of material failure and limitations on gathering data in the failure nucleation zone, this goal has often appeared out of reach; however, recent advances in instrumentation sensitivity, instrument density and data analysis show promise toward forecasting failure times. Here, we show that we can predict frictional failure times of both slow and fast stick slip failure events in the laboratory. This advance is made possible by applying a machine learning approach known as Random Forests1(RF) to the continuous acoustic emission (AE) time series recorded by detectors located on the fault blocks. The RF is trained using a large number of statistical features derived from the AE time series signal. The model is then applied to data not previously analyzed. Remarkably, we find that the RF method predicts upcoming failure time far in advance of a stick slip event, based only on a short time window of data. Further, the algorithm accurately predicts the time of the beginning and end of the next slip event. The predicted time improves as failure is approached, as other data features add to prediction. Our results show robust predictions of slow and dynamic failure based on acoustic emissions from the fault zone throughout the laboratory seismic cycle. The predictions are based on previously unidentified tremor-like acoustic signals that occur during stress build up and the onset of macroscopic frictional weakening. We suggest that the tremor-like signals carry information about fault zone processes and allow precise predictions of failure at any time in the slow slip or stick slip cycle2. If the laboratory experiments represent Earth frictional conditions, it could well be that signals are being missed that contain highly useful predictive information. 1Breiman

  18. Standardization and Digital Enclosure: The Privatization of Standards, Knowledge, and Policy in the Age of Global Information Technology. Part of the Advances in IT Standards and Standardization Research (AISSR) Book Series

    Science.gov (United States)

    Schoechle, Timothy, Ed.

    2009-01-01

    Recent trends have shown increasing privatization of standardization activities under various corporations, trade associations, and consortia, raising significant public policy issues about how the public interest may be represented. This book establishes a framework of analysis for public policy discussion and debate. Discussing topics such as…

  19. UNCONVENTIONAL MONETARY POLICY

    Directory of Open Access Journals (Sweden)

    DIACONESCU DIANA RALUCA

    2015-03-01

    Full Text Available Central banks in advanced economies have deployed a variety of unconventional policies during the crisis. It can be seen that the central banks have been mostly successful at achieving their objectives and that spillover to other countries have—thus far at least—been benign overall. Also it can be considered that using unconventional measures may be appropriate in some circumstances, but also they can have disadvantages and all the benefits for using such measures need to be balanced against potential costs. Prior to the crisis the monetary policy was implemented by central banks in a predictable and systematic way, and its transmission mechanism was understood by the economic agents. A transparent central bank reaction function (or broad rule guided market expectations of future interest rates. After the crisis appeared, the central banks from developed countries applied unconventional tools1 to address two important objectives: first one is to restore the proper functioning of financial markets and intermediation, and second one is to provide further monetary policy accommodation. Both these objectives need to support financial stability, including the diminishing big risks in acute phases of the crisis (collapse of the financial system, depression, and deflation. This paper reviews recent experience with these policies and considers issues related to their continued use in the future in the Romanian economy. It will be a tentative to explain how to avoid liquidity trap2 or get out of it – these also can be seen in the Romanian economy in the last few years.

  20. An Overview of Macroprudential Policy Tools

    NARCIS (Netherlands)

    Claessens, S.

    2014-01-01

    Macroprudential policies - caps on loan to value ratios, limits on credit growth and other balance sheets restrictions, (countercyclical) capital and reserve requirements and surcharges, and Pigouvian levies - have become part of the policy paradigm in emerging markets and advanced countries alike.

  1. 2011 State Teacher Policy Yearbook. Kansas

    Science.gov (United States)

    National Council on Teacher Quality, 2011

    2011-01-01

    For five years running, the National Council on Teacher Quality (NCTQ) has tracked states' teacher policies, preparing a detailed and thorough compendium of teacher policy in the United States on topics related to teacher preparation, licensure, evaluation, career advancement, tenure, compensation, pensions and dismissal. The 2011 State Teacher…

  2. 2011 State Teacher Policy Yearbook. Hawaii

    Science.gov (United States)

    National Council on Teacher Quality, 2011

    2011-01-01

    For five years running, the National Council on Teacher Quality (NCTQ) has tracked states' teacher policies, preparing a detailed and thorough compendium of teacher policy in the United States on topics related to teacher preparation, licensure, evaluation, career advancement, tenure, compensation, pensions and dismissal. The 2011 State Teacher…

  3. An Overview of Macroprudential Policy Tools

    NARCIS (Netherlands)

    Claessens, S.

    2014-01-01

    Macroprudential policies - caps on loan to value ratios, limits on credit growth and other balance sheets restrictions, (countercyclical) capital and reserve requirements and surcharges, and Pigouvian levies - have become part of the policy paradigm in emerging markets and advanced countries alike.

  4. 2011 State Teacher Policy Yearbook. Indiana

    Science.gov (United States)

    National Council on Teacher Quality, 2011

    2011-01-01

    For five years running, the National Council on Teacher Quality (NCTQ) has tracked states' teacher policies, preparing a detailed and thorough compendium of teacher policy in the United States on topics related to teacher preparation, licensure, evaluation, career advancement, tenure, compensation, pensions and dismissal. The 2011 State Teacher…

  5. [Heart failure and comorbidities].

    Science.gov (United States)

    Boully, Clémence; Hanon, Olivier

    2015-03-01

    Heart failure is a frequent disease in the elderly. Its clinical presentation is less typical and the prognosis more severe than in younger subjects because heart failure occurs in patients with multiple comorbidities. A comprehensive geriatric assessment should therefore be performed to detect the vulnerabilities and manage the comorbidities. The main diseases associated with heart failure are dementia, depression, malnutrition, atrial fibrillation, coronary artery disease, orthostatic hypotension, renal failure, anemia and iron deficiency. Comorbidities worsen heart failure and makes its treatment more difficult. The identification and treatment of comorbidities improve the prognosis in terms of mortality but especially in terms of quality of life. Caution with drugs is necessary because of pharmacokinetic or pharmacodynamic changes related to aging and the comorbidities. In this context, clinical and laboratory monitoring should be increased, mostly during an acute event (acute heart failure, infection, dehydration, fall, new therapy…). Therefore, the follow-up of elderly patients with heart failure requires a multidisciplinary approach that involves close cooperation between cardiologists, geriatricians, general practitioners, nurses, and pharmacists.

  6. Potential of gene therapy as a treatment for heart failure

    OpenAIRE

    2013-01-01

    Advances in understanding the molecular basis of myocardial dysfunction, together with the evolution of increasingly efficient gene transfer technology, make gene-based therapy a promising treatment option for heart conditions. Cardiovascular gene therapy has benefitted from recent advancements in vector technology, design, and delivery modalities. There is a critical need to explore new therapeutic approaches in heart failure, and gene therapy has emerged as a viable alternative. Advances in...

  7. Damage mechanics - failure modes

    Energy Technology Data Exchange (ETDEWEB)

    Krajcinovic, D.; Vujosevic, M. [Arizona State Univ., Tempe, AZ (United States)

    1996-12-31

    The present study summarizes the results of the DOE sponsored research program focused on the brittle failure of solids with disordered microstructure. The failure is related to the stochastic processes on the microstructural scale; namely, the nucleation and growth of microcracks. The intrinsic failure modes, such as the percolation, localization and creep rupture, are studied by emphasizing the effect of the micro-structural disorder. A rich spectrum of physical phenomena and new concepts that emerges from this research demonstrates the reasons behind the limitations of traditional, deterministic, and local continuum models.

  8. NEW HORIZONS IN THE MANAGEMENT OF HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Puneeta

    2016-04-01

    Full Text Available INTRODUCTION Heart failure (HF is a global problem with an estimated prevalence of 38 million people worldwide; a number that is increasing with the ageing of the population. The heart failure is associated with high health expenditure, mostly because of cost of hospitalisations. The five year survival for individuals with heart failure is about 50%, and in advanced heart failure, the one year survival is as low as 22%, regardless of therapy. The modern history of therapy for heart failure with reduced ejection fraction began with the introduction of vasodilatation with hydralazine plus isosorbide dinitrate. Research about heart failure is now quite active worldwide and many areas are being explored e.g. gene therapy, modification of function of micro RNAs by antagomirs, stem cell therapy besides development of new pharmacological therapeutic agents.

  9. Essays on Energy Technology Innovation Policy

    Science.gov (United States)

    Chan, Gabriel Angelo Sherak

    reform. Policies to "unlock" publicly sponsored inventions from the organizations that develop them have broad impact on private sector innovation. These policies multiply the effect of public research and development funds, but should be strengthened to more rapidly advance the scientific frontier. The second chapter of this dissertation provides some of the first quantitative evidence to support reform in this area. Finally, international policies to facilitate the deployment of climate-friendly technologies in developing countries face serious implementation challenges. The current paradigm of utilizing carbon markets to fund individual projects that would not have otherwise occurred has failed to encourage energy technology deployment in one of the sectors with the greatest experience with such policies. The third chapter of this dissertation suggests that this failure has been largely due to poorly designed procedural rules, but options for reform are available. Mitigation of global climate change will require broad policy response across the full range of scales, sectors, and policy spheres. Undoubtedly, climate mitigation will result in widespread transformation of energy systems. This dissertation focuses on the role of innovation policy in accelerating the transformation of these systems. The range of policies studied in this dissertation can make climate change mitigation more politically feasible and more cost effective by expanding the set of technological choices available to public and private actors faced with incentives and requirements to lower their greenhouse gas emissions to collectively safe levels.

  10. A study of rock bolting failure modes

    Institute of Scientific and Technical Information of China (English)

    Cao Chen; Jan Nemcik; Ren Ting; Naj Aziz

    2013-01-01

    Rock bolting has advanced rapidly during the past 4 decades due to a better understanding of load transfer mechanisms and advances made in the bolt system technology.Bolts are used as permanent and temporary support systems in tunnelling and mining operations.A review of has indicated that three systems of reinforcement devices have evolved as part of rock bolt and ground anchor while the rock is not generally thought of as being a component of the reinforcement system.A classification of rock bolting reinforcement systems is presented,followed by the fundamental theory of the load transfer mechanism.The failure mode of two phases of rock bolting system is formularised.The failure modes of cable bolting are discussed using a bond strength model as well as an iterative method.Finally,the interfacial shear stress model for ribbed bar is introduced and a closed form solution is obtained using a tri-line stress strain relationship.

  11. Recruit and ADVANCE

    Science.gov (United States)

    Rosser, Sue V.

    2007-04-01

    Beginning in 2001, the National Science Foundation launched the ADVANCE Initiative, which has now awarded more than 70 million to some thirty institutions for transformations to advance women. Results of studies on how to attract and retain women students and faculty underpinned our ADVANCE Institutional Transformation grant funded by the NSF for 3.7 million for five years, beginning in 2001. As co-principal investigator on this grant, I insured that this research informed the five major threads of the grant: 1) Four termed ADVANCE professors to mentor junior women faculty in each college; 2) Collection of MIT-Report-like data indicators to assess whether advancement of women really occurs during and after the institutional transformation undertaken through ADVANCE; 3) Family-friendly policies and practices to stop the tenure clock and provide active service, modified duties, lactation stations and day care; 4) Mini-retreats to facilitate access for tenure-track women faculty to male decision-makers and administrators for informal conversations and discussion on topics important to women faculty; 5) Removal of subtle gender, racial, and other biases in promotion and tenure. The dynamic changes resulting from the grant in quality of mentoring, new understanding of promotion and tenure, numbers of women retained and given endowed chairs, and emergence of new family friendly policies gave me hope for genuine diversification of leadership in science and technology. As the grant funding ends, the absence of NSF prestige and monitoring, coupled with a change in academic leadership at the top, provide new challenges for institutionalization, recruitment, and advancement of women into leadership positions in science and engineering.

  12. [Diuretic therapy in heart failure].

    Science.gov (United States)

    Trullàs, Joan Carles; Morales-Rull, José Luís; Formiga, Francesc

    2014-02-20

    Many of the primary clinical manifestations of heart failure (HF) are due to fluid retention, and treatments targeting congestion play a central role in HF management. Diuretic therapy remains the cornerstone of congestion treatment, and diuretics are prescribed to the majority of HF patients. Despite this ubiquitous use, there is limited evidence from prospective randomized studies to guide the use of diuretics. With the chronic use of diuretic and usually in advanced stages of HF, diuretics may fail to control salt and water retention. This review describes the mechanism of action of available diuretic classes, reviews their clinical use based on scientific evidence and discusses strategies to overcome diuretic resistance. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. On-Board Particulate Filter Failure Prevention and Failure Diagnostics Using Radio Frequency Sensing

    Energy Technology Data Exchange (ETDEWEB)

    Sappok, Alex [Filter Sensing Technologies; Ragaller, Paul [Filter Sensing Technologies; Herman, Andrew [CTS Corporation; Bromberg, L. [Massachusetts Institute of Technology (MIT); Prikhodko, Vitaly Y [ORNL; Parks, II, James E [ORNL; Storey, John Morse [ORNL

    2017-01-01

    The increasing use of diesel and gasoline particulate filters requires advanced on-board diagnostics (OBD) to prevent and detect filter failures and malfunctions. Early detection of upstream (engine-out) malfunctions is paramount to preventing irreversible damage to downstream aftertreatment system components. Such early detection can mitigate the failure of the particulate filter resulting in the escape of emissions exceeding permissible limits and extend the component life. However, despite best efforts at early detection and filter failure prevention, the OBD system must also be able to detect filter failures when they occur. In this study, radio frequency (RF) sensors were used to directly monitor the particulate filter state of health for both gasoline particulate filter (GPF) and diesel particulate filter (DPF) applications. The testing included controlled engine dynamometer evaluations, which characterized soot slip from various filter failure modes, as well as on-road fleet vehicle tests. The results show a high sensitivity to detect conditions resulting in soot leakage from the particulate filter, as well as potential for direct detection of structural failures including internal cracks and melted regions within the filter media itself. Furthermore, the measurements demonstrate, for the first time, the capability to employ a direct and continuous monitor of particulate filter diagnostics to both prevent and detect potential failure conditions in the field.

  14. Cyber policy in China

    CERN Document Server

    Austin, Greg

    2014-01-01

    Few doubt that China wants to be a major economic and military power on the world stage. To achieve this ambitious goal, however, the PRC leadership knows that China must first become an advanced information-based society. But does China have what it takes to get there? Are its leaders prepared to make the tough choices required to secure China's cyber future? Or is there a fundamental mismatch between China's cyber ambitions and the policies pursued by the CCP until now? This book offers the first comprehensive analysis of China's information society. It explores the key practic

  15. International industrial sector energy efficiency policies

    Energy Technology Data Exchange (ETDEWEB)

    Price, Lynn; Worrell, Ernst

    2000-01-01

    Over 40 percent of the energy consumed globally is used in the industrial sector. In China, this sector consumes an even larger proportion, reaching nearly 70 percent in 1997. A variety of energy efficiency policies and programs have been instituted in both industrialized and developing countries in an effort to improve the energy efficiency of the industrial sector. There are very few comprehensive evaluations of these industrial sector energy efficiency policies; however a number of recent workshops and conferences have included a focus on these policies. Three important meetings were the International Energy Agency's Industrial Energy Efficiency: Policies and Programs Conference in 1994, Industrial Energy Efficiency Policies: Understanding Success and Failure - A Workshop Organized by the International Network for Energy Demand Analysis in the Industrial Sector in 1998, and the American Council for an Energy-Efficient Economy's 1999 Summer Study on Energy Efficiency in Industry. Man y articles from these meetings are included as attachments to this memo. This paper provides a brief description of each of seven categories of individual industrial energy efficiency policies and programs, discuss which industrial sectors or types of equipment they apply to, and provide references for articles and reports that discuss each policy or program in more detail. We begin with mandatory-type policies and move to more voluntary-type policies. We then provide a brief description of four integrated industrial energy efficiency policies and provide references for articles and reports that describe these policies in greater detail.

  16. Policy restrictions, democratic deficit and redistribution

    OpenAIRE

    2008-01-01

    Restrictions to the range of policies available to governments are often recommended as a solution to coordination failures or time inconsistency problems. However, policy restrictions can have important drawbacks that have been generally ignored so far. When the hands of governments are tied, citizens have lower incentives to be informed on political matters and to participate in collective decision-making processes, since private returns from political information are lower. This mechanism ...

  17. Chronic Renal Failure, Cachexia, and Ghrelin

    OpenAIRE

    Laviano, A.; Krznaric, Z.; Sanchez-Lara, K.; Preziosa, I.; Cascino, A; Rossi Fanelli, F.

    2010-01-01

    Protein energy wasting is frequently observed in patients with advanced chronic renal failure and end-stage renal disease. Anorexia and reduced food intake are critical contributing factors and negatively impact on patients' survival. Ghrelin is a prophagic peptide produced by the stomach and acting at the hypothalamic level to increase the activity of orexigenic neurons. In patients with chronic renal disease, plasma levels are increased as a likely effect of reduced renal clearance. Neverth...

  18. Language Policy

    DEFF Research Database (Denmark)

    Lauridsen, Karen M.

    2008-01-01

    Like any other text, instructive texts function within a given cultural and situational setting and may only be available in one language. However, the end users may not be familiar with that language and therefore unable to read and understand the instructions. This article therefore argues...... that instructive texts should always be available in a language that is understood by the end users, and that a corporate communication policy which includes a language policy should ensure that this is in fact the case for all instructive texts....

  19. Population policy.

    Science.gov (United States)

    1987-03-01

    Participants in the Seminar on Population Policies for Top-level Policy Makers and Program Managers, meeting in Thailand during January 1987, examined the challenges now facing them regarding the implementation of fertility regulation programs in their respective countries -- Bangladesh, China, India, Indonesia, Malaysia, Nepal, Pakistan, the Philippines, the Republic of Korea, and Thailand. This Seminar was organized to coincide with the completion of an Economic and Social Commission for Asia and the Pacific (ESCAP) study investigating the impact and efficiency of family planning programs in the region. Country studies were reviewed at the Seminar along with policy issues about the status of women, incentive and disincentive programs, and socioeconomic factors affecting fertility. In Bangladesh the government recognizes population growth as its top priority problem related to the socioeconomic development of the country and is working to promote a reorientation strategy from the previous clinic-oriented to a multidimensional family welfare program. China's family planning program seeks to postpone marraige, space the births of children between 3-5 years, and promote the 1-child family. Its goal is to reduce the rate of natural increase from 12/1000 in 1978 to 5/1000 by 1985 and 0 by 2000. India's 7th Five-Year-Plan (1986-90) calls for establishing a 2-child family norm by 2000. In Indonesia the government's population policy includes reducing the rate of population growth, achieving a redistribution of the population, adjusting economic factors, and creating prosperous families. The government of Indonesia reversed its policy to reduce the population growth rate in 1984 and announced its goal of achieving a population of 70 million by 2100 in order to support mass consumption industries. It has created an income tax deduction system favoring large families and maternity benefits for women who have up to 5 children as incentives. Nepal's official policy is to

  20. Hyperkalemia in Heart Failure.

    Science.gov (United States)

    Sarwar, Chaudhry M S; Papadimitriou, Lampros; Pitt, Bertram; Piña, Ileana; Zannad, Faiez; Anker, Stefan D; Gheorghiade, Mihai; Butler, Javed

    2016-10-01

    Disorders of potassium homeostasis can potentiate the already elevated risk of arrhythmia in heart failure. Heart failure patients have a high prevalence of chronic kidney disease, which further heightens the risk of hyperkalemia, especially when renin-angiotensin-aldosterone system inhibitors are used. Acute treatment for hyperkalemia may not be tolerated in the long term. Recent data for patiromer and sodium zirconium cyclosilicate, used to treat and prevent high serum potassium levels on a more chronic basis, have sparked interest in the treatment of hyperkalemia, as well as the potential use of renin-angiotensin-aldosterone system inhibitors in patients who were previously unable to take these drugs or tolerated only low doses. This review discusses the epidemiology, pathophysiology, and outcomes of hyperkalemia in heart failure; provides an overview of traditional and novel ways to approach management of hyperkalemia; and discusses the need for further research to optimally treat heart failure.

  1. Heart failure - medicines

    Science.gov (United States)

    ... are working and to measure your potassium levels. Beta Blockers Beta blockers slow your heart rate and decrease the strength ... muscle contracts in the short term. Long term beta blockers help keep your heart failure from becoming worse. ...

  2. Central oxygen pipeline failure

    African Journals Online (AJOL)

    Anaesthetic and critical care staff play a governing role in the comprehension of a ... complete central oxygen pipeline failure occurred throughout. Tygerberg Hospital. ..... emergency stations and at plant room emergency supply manifolds.

  3. Acute heart failure syndrome

    African Journals Online (AJOL)

    tandfonline.com/ ... When heart failure develops gradually, there is time for the compensatory ... of this can be seen in acute brain injury, some forms of takotsubo syndrome or .... reduce blood pressure in cases presenting with elevated blood pressure.

  4. Research and health policy

    Directory of Open Access Journals (Sweden)

    Abu Bakar Suleiman

    2013-04-01

    Full Text Available Healthcare investment is critically important for thehealth and well-being of the population, and differenthealth systems are developed to meet the needs andpriorities of each country. What has become clear hasbeen that despite major advances in medicine, scienceand technology, there are major issues related toaccess and equity as well as quality and patient safetyin healthcare services. The issue of patient safety washighlighted by the reports of the Institute of Medicine,USA1,2 and this had received worldwide attention.It is also an irony that despite being in an age ofmajor advances in medicine, science and technology,with the acceptance of evidence-based medicine,so much of medicine and healthcare delivered is oflittle or no proven value. This poses a major challengeon health policy, and on how this can be addressed inany health reform process that focuses on improvingaccess, equity, efficiency and effectiveness in healthcareservices.

  5. Symptom management challenges in heart failure: pharmacotherapy considerations.

    Science.gov (United States)

    Stewart, Diana; McPherson, Mary Lynn

    2017-06-24

    Heart failure is a chronic, progressive illness that is increasing in prevalence in the USA. Patients with advanced heart failure experience a high symptom burden that is comparable to patients with advanced cancer. Palliative care, however, is underutilized in patients with heart failure, and symptoms may go untreated as the disease progresses. A combination of pharmacologic and non-pharmacologic interventions should be used to address symptoms and maintain quality of life. While there have been significant advances in evidence-based heart failure treatments in recent years, selection of appropriate palliative medications as symptoms progress is challenging due to limited clinical studies in this patient population. Medications that are commonly used for symptom management in other life-limiting illnesses may have little to no evidence in heart failure, or have undesirable cardiac effects that preclude use. Clinicians must extrapolate available clinical evidence and prescribing considerations relevant to heart failure to palliate symptoms as well as possible. The objectives of this paper are to review the most common and distressing symptoms in heart failure, analyze evidence, or lack thereof, for pharmacologic management of symptoms, and provide prescribing considerations based on side effect profiles and comorbid conditions.

  6. Renal failure (chronic)

    OpenAIRE

    Clase, Catherine

    2011-01-01

    Chronic renal failure is characterised by a gradual and sustained decline in renal clearance or glomerular filtration rate (GFR). Continued progression of renal failure will lead to renal function too low to sustain healthy life. In developed countries, such people will be offered renal replacement therapy in the form of dialysis or renal transplantation. Requirement for dialysis or transplantation is termed end-stage renal disease (ESRD).Diabetes, glomerulonephritis, hypertension, pyelone...

  7. Lungs in Heart Failure

    Directory of Open Access Journals (Sweden)

    Anna Apostolo

    2012-01-01

    Full Text Available Lung function abnormalities both at rest and during exercise are frequently observed in patients with chronic heart failure, also in the absence of respiratory disease. Alterations of respiratory mechanics and of gas exchange capacity are strictly related to heart failure. Severe heart failure patients often show a restrictive respiratory pattern, secondary to heart enlargement and increased lung fluids, and impairment of alveolar-capillary gas diffusion, mainly due to an increased resistance to molecular diffusion across the alveolar capillary membrane. Reduced gas diffusion contributes to exercise intolerance and to a worse prognosis. Cardiopulmonary exercise test is considered the “gold standard” when studying the cardiovascular, pulmonary, and metabolic adaptations to exercise in cardiac patients. During exercise, hyperventilation and consequent reduction of ventilation efficiency are often observed in heart failure patients, resulting in an increased slope of ventilation/carbon dioxide (VE/VCO2 relationship. Ventilatory efficiency is as strong prognostic and an important stratification marker. This paper describes the pulmonary abnormalities at rest and during exercise in the patients with heart failure, highlighting the principal diagnostic tools for evaluation of lungs function, the possible pharmacological interventions, and the parameters that could be useful in prognostic assessment of heart failure patients.

  8. Constructing Ontology for Knowledge Sharing of Materials Failure Analysis

    Directory of Open Access Journals (Sweden)

    Peng Shi

    2014-01-01

    Full Text Available Materials failure indicates the fault with materials or components during their performance. To avoid the reoccurrence of similar failures, materials failure analysis is executed to investigate the reasons for the failure and to propose improved strategies. The whole procedure needs sufficient domain knowledge and also produces valuable new knowledge. However, the information about the materials failure analysis is usually retained by the domain expert, and its sharing is technically difficult. This phenomenon may seriously reduce the efficiency and decrease the veracity of the failure analysis. To solve this problem, this paper adopts ontology, a novel technology from the Semantic Web, as a tool for knowledge representation and sharing and describes the construction of the ontology to obtain information concerning the failure analysis, application area, materials, and failure cases. The ontology represented information is machine-understandable and can be easily shared through the Internet. At the same time, failure case intelligent retrieval, advanced statistics, and even automatic reasoning can be accomplished based on ontology represented knowledge. Obviously this can promote the knowledge sharing of materials service safety and improve the efficiency of failure analysis. The case of a nuclear power plant area is presented to show the details and benefits of this method.

  9. Heart failure association of the European society of cardiology specialist heart failure curriculum.

    Science.gov (United States)

    McDonagh, Theresa A; Gardner, Roy S; Lainscak, Mitja; Nielsen, Olav W; Parissis, John; Filippatos, Gerasimos; Anker, Stefan D

    2014-02-01

    It is well established that organized care of heart failure patients, including specialist management by cardiologists, improves patient outcomes. In response to this, other national training bodies (the UK and the USA) have developed heart failure subspecialty curricula within their Cardiology Training Curricula. In addition, European Society of Cardiology (ESC) subspecialty curricula exist for Interventional Cardiology and Heart Rhythm Management. The purpose of this heart failure curriculum is to provide a framework which can be used as a blueprint for training across Europe. This blueprint mirrors other ESC curricula. Each section has three components: the knowledge required, the skills which are necessary, and the professionalism (attitudes and behaviours) which should be attained. The programme is designed to last 2 years. The first year is devoted to the specialist heart failure module. The second year allows completion of the optional modules of advanced imaging, device therapy for implanters, cardiac transplantation, and mechanical circulatory support. The second year can also be devoted to continuation of specialist heart failure training and/or research for those not wishing to continue with the advanced modules.

  10. Multidisciplinary management of chronic heart failure: principles and future trends.

    Science.gov (United States)

    Davidson, Patricia M; Newton, Phillip J; Tankumpuan, Thitipong; Paull, G; Dennison-Himmelfarb, Cheryl

    2015-10-01

    Globally, the management of chronic heart failure (CHF) challenges health systems. The high burden of disease and the costs associated with hospitalization adversely affect individuals, families, and society. Improved quality, access, efficiency, and equity of CHF care can be achieved by using multidisciplinary care approaches if there is adherence and fidelity to the program's elements. The goal of this article was to summarize evidence and make recommendations for advancing practice, education, research, and policy in the multidisciplinary management of patients with CHF. Essential elements of multidisciplinary management of CHF were identified from meta-analyses and clinical practice guidelines. The study factors were discussed from the perspective of the health care system, providers, patients, and their caregivers. Identified gaps in evidence were used to identify areas for future focus in CHF multidisciplinary management. Although there is high-level evidence (including several meta-analyses) for the efficacy of management programs for CHF, less evidence exists to determine the benefit attributable to individual program components or to identify the specific content of effective components and the manner of their delivery. Health care system, provider, and patient factors influence health care models and the effective management of CHF and require focus and attention. Extrapolating trial findings to clinical practice settings is limited by the heterogeneity of study populations and the implementation of models of intervention beyond academic health centers, where practice environments differ considerably. Ensuring that individual programs are both developed and assessed that consider these factors is integral to ensuring adherence and fidelity with the core dimensions of disease management necessary to optimize patient and organizational outcomes. Recognizing the complexity of the multidisciplinary CHF interventions will be important in advancing the design

  11. Treatment of respiratory failure in COPD

    Directory of Open Access Journals (Sweden)

    Stephan Budweiser

    2008-12-01

    Full Text Available Stephan Budweiser1, Rudolf A Jörres2, Michael Pfeifer1,31Center for Pneumology, Hospital Donaustauf, Donaustauf, Germany; 2Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany; 3Department of Internal Medicine II, Division of Respirology, University of Regensburg, Regensburg, GermanyAbstract: Patients with advanced COPD and acute or chronic respiratory failure are at high risk for death. Beyond pharmacological treatment, supplemental oxygen and mechanical ventilation are major treatment options. This review describes the physiological concepts underlying respiratory failure and its therapy, as well as important treatment outcomes. The rationale for the controlled supply of oxygen in acute hypoxic respiratory failure is undisputed. There is also a clear survival benefit from long-term oxygen therapy in patients with chronic hypoxia, while in mild, nocturnal, or exercise-induced hypoxemia such long-term benefits appear questionable. Furthermore, much evidence supports the use of non-invasive positive pressure ventilation in acute hypercapnic respiratory failure. It application reduces intubation and mortality rates, and the duration of intensive care unit or hospital stays, particularly in the presence of mild to moderate respiratory acidosis. COPD with chronic hypercapnic respiratory failure became a major indication for domiciliary mechanical ventilation, based on pathophysiological reasoning and on data regarding symptoms and quality of life. Still, however, its relevance for long-term survival has to be substantiated in prospective controlled studies. Such studies might preferentially recruit patients with repeated hypercapnic decompensation or a high risk for death, while ensuring effective ventilation and the patients’ adherence to therapy.Keywords: respiratory failure, COPD, mechanical ventilation, non-invasive ventilation long-term oxygen therapy, chronic

  12. A Complexity-Theoretic Perspective on Innovation Policy

    NARCIS (Netherlands)

    Frenken, K.

    2016-01-01

    It is argued that innovation policy based on notions of market failure or system failure is too limited in the context of current societal challenges. I propose a third, complexity-theoretic approach. This approach starts from the observation that most innovations are related to existing activities,

  13. Advancing Efforts to Energize Native Alaska (Brochure)

    Energy Technology Data Exchange (ETDEWEB)

    2013-04-01

    This brochure describes key programs and initiatives of the DOE Office of Indian Energy Policy and Programs to advance energy efficiency, renewable energy, and energy infrastructure projects in Alaska Native villages.

  14. Treatment of anemia in heart failure patients

    Directory of Open Access Journals (Sweden)

    Miran Šebeštjen

    2010-02-01

    Full Text Available h e prevalence of anemia in patients with advanced heart failure is signii cant and is present in more than 50 % of this patient population. h e exact pathophysiologic mechanism of anemia in heart failure is still not known – it could be a direct consequence of the heart failure or it could be caused by some other disease in this population of polymorbid patients. h ere are several mechanisms through which heart failure could contribute to the development of anemia. h e most plausible among them are hemodilution, renal insui ciency, increased proinl ammatory cytokines, malnutrition, decreased erhythropoiesis in bone marrow and heart-failure medications (predominantly ACEI. Anemia is an independant risk factor for recurrent hospitalizations and increased mortality. Several small-scale studies demonstrated that the treatment of anemia in heart-failure patients decreased heart failure signs and symptoms in this patient population. Anemia in heart-failure patients can be treated with: blood transfusion, iron replacement therapy, or with synthetic analogues of erhythropoietin. Before the treatment with synthetic analogues of erhythropoietin. is started, other causes of anemia (gastrointestinal bleeding, malnutrition, renal insui ciency, hematological diseases and malignancies have to be excluded. Iron blood levels, ferritin, transferrin and TIBC also have to be determined. If body iron stores are depleted, iron has to be replaced intravenously, the target levels of ferritin being around 250 ng/mL. If anemia persists at er 2 weeks of iron replacement therapy, treatment with erhythropoietin is indicated. Currently 4 erhythropoietin analogues are available: epoetin α (Eprex®, epoetin β (NeoRecormon®, darbepoetin α (Aranesp® and metoksipolietilenglikol epoetin β (Mircera®. Anemia needs to be treated in all NYHA III and IV heart failure patients and hemoglobin levels below 110 g/dL. h e treatment of anemia with erhythropoietin and the adjustment

  15. Predictive Manufacturing: A Classification Strategy to Predict Product Failures

    DEFF Research Database (Denmark)

    Khan, Abdul Rauf; Schiøler, Henrik; Kulahci, Murat

    2017-01-01

    Predicting failures can be considered a meaningful insight for the optimal planning of an industrial manufacturing process. In this era of advanced sensor technologies, when the collection of data from each step of the manufacturing process is common practice and advanced analytical skills enable...... us to efficiently analyze heterogeneous data streams, predicting failure becomes an achievable task. In this article: first, we propose a data mining strategy to deal with heterogeneous streams of data to predict failures in the production process; second, we aim to build a novel predictive...... manufacturing analytics model that employs a big data approach to predicting product failures; third, we illustrate the issue of high dimensionality, along with statistically redundant information; and, finally, our proposed method will be compared against the well-known classification methods (SVM, K...

  16. [Heart failure and anemia].

    Science.gov (United States)

    Reda, S; Motloch, L J; Hoppe, U C

    2013-09-01

    Chronic heart failure has an age-dependent prevalence of 2% and is therefore one of the most frequent diseases in western societies. A reduced hemoglobin concentration according to the definition of the World Health Organization is a common comorbidity affecting more than half of all heart failure patients. Elderly patients, patients suffering from renal impairment and women are more likely to develop anemia but a definitive etiology of anemia is only identified in the minority of cases. Anemia is associated with a poor clinical status and a greater risk of hospitalization and is a predictive factor for increased mortality. The incidence of anemia appears to increase with a poorer functional class. Intravenous iron therapy improves the exercise capacity in patients with systolic heart failure and iron deficiency and is currently being recommended for patients with persistent symptoms despite optimal medical and device therapy. However, erythropoietin-stimulating agents as a treatment for anemia in chronic heart failure have failed to improve clinical outcome in a large randomized trial. In patients with heart failure but with maintained ejection fraction, anemia is also associated with a poor prognosis. Specific therapeutic recommendations for these patients are still not available.

  17. Ejection Fraction Heart Failure Measurement

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More Ejection Fraction Heart Failure Measurement Updated:Feb 15,2017 The ejection fraction ( ... failure This content was last reviewed April 2015. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  18. Disease management programs for heart failure: not just for the 'sick' heart failure population.

    Science.gov (United States)

    McDonald, Ken; Conlon, Carmel; Ledwidge, Mark

    2007-02-01

    The development of disease management programs has been a major advance in heart failure care, bringing about significant improvements for the heart failure population, with reduction in readmission, better use of guideline therapy and improved survival. However, at present, the majority of such programs focus their attention only on the sicker segment of this population, with little application of this important service to the broader heart failure population, where potentially benefits may be even more impressive. This has led to an imbalance in the care of patients with heart failure, where aspects of management such as regular structured review and education are preferentially given to the group at the later stages of the natural history of the syndrome. This paper argues for a far wider application of the disease management program concept in heart failure care so as to bring the benefits of specialist care, patient education and follow-up to patients at an earlier stage in the natural history of heart failure.

  19. Policies facilitating firm adjustment to globalization

    OpenAIRE

    Hoekman, Bernard; Javorcik, Beata Smarzynska

    2004-01-01

    The authors focus on policies facilitating firm adjustment to globalization. They briefly review the effects of trade and investment liberalization on firms, focusing on within-industry effects. They postulate that governments' role in supporting the process is to (1) ensure that firms face "right" incentives to adjust, and (2) intervene in areas where market failures are present. Their ma...

  20. BIOASSAY VESSEL FAILURE ANALYSIS

    Energy Technology Data Exchange (ETDEWEB)

    Vormelker, P

    2008-09-22

    Two high-pressure bioassay vessels failed at the Savannah River Site during a microwave heating process for biosample testing. Improper installation of the thermal shield in the first failure caused the vessel to burst during microwave heating. The second vessel failure is attributed to overpressurization during a test run. Vessel failure appeared to initiate in the mold parting line, the thinnest cross-section of the octagonal vessel. No material flaws were found in the vessel that would impair its structural performance. Content weight should be minimized to reduce operating temperature and pressure. Outer vessel life is dependent on actual temperature exposure. Since thermal aging of the vessels can be detrimental to their performance, it was recommended that the vessels be used for a limited number of cycles to be determined by additional testing.

  1. Ductile failure modeling

    DEFF Research Database (Denmark)

    Benzerga, Ahmed Amine; Leblond, Jean Baptiste; Needleman, Alan

    2016-01-01

    anisotropy, or the influence of nonlocal effects that bring a material size scale into the models. Often the voids are not present in the material from the beginning, and realistic nucleation models are important. The final failure process by coalescence of neighboring voids is an issue that has been given......Ductile fracture of structural metals occurs mainly by the nucleation, growth and coalescence of voids. Here an overview of continuum models for this type of failure is given. The most widely used current framework is described and its limitations discussed. Much work has focused on extending void...... growth models to account for non-spherical initial void shapes and for shape changes during growth. This includes cases of very low stress triaxiality, where the voids can close up to micro-cracks during the failure process. The void growth models have also been extended to consider the effect of plastic...

  2. Internet Policy

    Science.gov (United States)

    Lehr, William H.; Pupillo, Lorenzo Maria

    The Internet is now widely regarded as essential infrastructure for our global economy and society. It is in our homes and businesses. We use it to communicate and socialize, for research, and as a platform for E-commerce. In the late 1990s, much was predicted about what the Internet has become at present; but now, we have actual experience living with the Internet as a critical component of our everyday lives. Although the Internet has already had profound effects, there is much we have yet to realize. The present volume represents a third installment in a collaborative effort to highlight the all-encompassing, multidisciplinary implications of the Internet for public policy. The first installment was conceived in 1998, when we initiated plans to organize an international conference among academic, industry, and government officials to discuss the growing policy agenda posed by the Internet. The conference was hosted by the European Commission in Brussels in 1999 and brought together a diverse mix of perspectives on what the pressing policy issues would be confronting the Internet. All of the concerns identified remain with us today, including how to address the Digital Divide, how to modify intellectual property laws to accommodate the new realities of the Internet, what to do about Internet governance and name-space management, and how to evolve broadcast and telecommunications regulatory frameworks for a converged world.

  3. Cross-Sectional Predictors of "Risk" for School Failure

    Science.gov (United States)

    Petridou, Alexandra; Karagiorgi, Yiasemina

    2016-01-01

    Since school failure has detrimental effects on students and on society, education policy needs to address students "at risk," and support them to reach their potential. This study used data from the longitudinal national Programme for Functional Literacy (PfL) conducted in Cyprus to identify students "at risk" and aimed to…

  4. Rate of Failure of Czech Family Firms

    Directory of Open Access Journals (Sweden)

    Ondřej Machek

    2016-06-01

    Full Text Available Family business is becoming a promising area of research in post-socialist countries, including the Czech Republic. Stability belongs to frequently cited properties of family firms. The goal of this article is to test the hypothesis whether family firms tend to have a lower rate of failure than their non-family counterparts. Using a sample of 1148 family and 5972 non-family firms in the Czech Republic, we find that there is no significant relationship between family involvement and rate of failure. A possible greater stability of family businesses is not necessarily linked with a lower rate of bankruptcy. We also discuss possible reasons and policy implications.

  5. Participants' Understanding of the Treatment in Policy Experimentation

    Science.gov (United States)

    Nicholson, Walter; Wright, Sonia R.

    1977-01-01

    Participants' understanding of the treatment in social science experiments is raised as an issue in the specification of statistical models of policy evaluation. A statistical model is offered which shows that failure to consider participants' understanding may introduce biases of unknown direction into policy parametric estimates. (Author/JKS)

  6. For a sustainable petroleum policy; Por uma politica petroleira sustentavel

    Energy Technology Data Exchange (ETDEWEB)

    Almeida, Edmar Luiz Fagundes de

    2007-07-01

    This article, considering the rising of petroleum derivatives, establishes a debate on the suitability of the present brazilian petroleum policy and possible market failures considering the following aspects: the reformulation on brazilian petroleum sector process; the economic and social impacts of the opening process; and the possibility of an alternative policy.

  7. US energy policies: Will they be responsive to future needs?

    Energy Technology Data Exchange (ETDEWEB)

    Hemphill, J.G.

    1995-12-31

    This paper reviews the history of early US energy policy as a prescription for failure, the evolution of national goals in energy, and the basic principles of energy policy (market based, clean energy alternatives should receive recognition; energy and environment planning coordinated; progress measured and adjustments made; technology transfer encouraged; government assistance should support economic and environmental objectives).

  8. Failure of granular assemblies

    OpenAIRE

    Welker, Philipp

    2011-01-01

    This work investigates granular assemblies subjected to increasing external forces in the quasi-static limit. In this limit, the system’s evolution depends on static properties of the system, but is independent of the particles’ inertia. At the failure, which occurs at a certain value of the external forces, the particles’ motions increase quickly. In this thesis, the properties of granular systems during the weakening process and at the failure are investigated with the Discrete Element Meth...

  9. Modeling Epidemic Network Failures

    DEFF Research Database (Denmark)

    Ruepp, Sarah Renée; Fagertun, Anna Manolova

    2013-01-01

    the SID model’s behavior and impact on the network performance, as well as the severity of the infection spreading. The simulations are carried out in OPNET Modeler. The model provides an important input to epidemic connection recovery mechanisms, and can due to its flexibility and versatility be used......This paper presents the implementation of a failure propagation model for transport networks when multiple failures occur resulting in an epidemic. We model the Susceptible Infected Disabled (SID) epidemic model and validate it by comparing it to analytical solutions. Furthermore, we evaluate...

  10. Modeling Epidemic Network Failures

    DEFF Research Database (Denmark)

    Ruepp, Sarah Renée; Fagertun, Anna Manolova

    2013-01-01

    This paper presents the implementation of a failure propagation model for transport networks when multiple failures occur resulting in an epidemic. We model the Susceptible Infected Disabled (SID) epidemic model and validate it by comparing it to analytical solutions. Furthermore, we evaluate...... the SID model’s behavior and impact on the network performance, as well as the severity of the infection spreading. The simulations are carried out in OPNET Modeler. The model provides an important input to epidemic connection recovery mechanisms, and can due to its flexibility and versatility be used...... to evaluate multiple epidemic scenarios in various network types....

  11. Automotive component failures

    CSIR Research Space (South Africa)

    Heyes, AM

    1998-06-01

    Full Text Available be expected[ 023 A[ M[ HEYES Fig[ 6[ Low magni_cation fractograph showing the seam defect "S#\\ fatigue area "F# and the brittle fracture area "B#[ Fig[ 7[ Fracture surface marked F in Fig[ 6\\ typical of a fatigue fracture surface in a high strength steel... Ltd[ All rights reserved[ Keywords] Accident investigation\\ automotive failures\\ decarburization\\ fatigue\\ weld fatigue[ 0[ INTRODUCTION Failure of automotive components is an occurrence which a}ects the life of almost every person at one stage...

  12. Lactulose and renal failure.

    Science.gov (United States)

    Vogt, B; Frey, F J

    1997-01-01

    The introduction of lactulose as a new therapeutic agent for treatment of hepatic encephalopathy was a major breakthrough in this field. It was hypothesized that lactulose might prevent postoperative renal impairment after biliary surgery in patients with obstructive jaundice. The presumable mechanism purported was the diminished endotoxinemia by lactulose. Unfortunately, such a reno-protective effect has not been shown conclusively until now in clinical studies. In chronic renal failure lactulose is known to promote fecal excretion of water, sodium, potassium, amonium, urea, creatinine and protons. Thus, lactulose could be useful for the treatment of chronic renal failure. However, compliance to the therapy represents a major problem.

  13. Coping with System Failure: Why Connectivity Matters to Innovation Policy

    DEFF Research Database (Denmark)

    Ricard, Lykke Margot

    2015-01-01

    it to reach its climate goals for 2020. The chapter’s research strategy stresses the importance of relations rather than the determinism of technology or ideas. As a result, the chapter’s structural analysis shows how firms in the modern European economy work, on a collective level, from within the political...... system to create new institutional structures in the economy. A major social network analysis examines how connectivity in two specific European ‘technology’ platforms’ networks has changed and evolved in relation to researching the solutions to solving major societal problems, and therefore has also...

  14. The cardiorenal link in advanced cirrhosis

    DEFF Research Database (Denmark)

    Krag, Aleksander; Bendtsen, Flemming; Burroughs, Andrew K

    2012-01-01

    and impaired cardiac function in patients with advanced cirrhosis. Cirrhotic cardiomyopathy has been described as a condition with impaired contractile responsiveness to stress and altered diastolic relaxation. We propose a cardiorenal interaction in patients with advanced cirrhosis and renal dysfunction......A considerable number of patients with advanced cirrhosis develop a hepatorenal syndrome. The pathogenesis involves liver dysfunction, splanchnic vasodilatation, and activation of vasoconstrictive systems. There are now several observations that indicate a relation between the renal failure...

  15. Technical analysis, contestation and politics in policy agenda setting and implementation : the rise and fall of primary care maternal services from Ghana’s capitation policy

    NARCIS (Netherlands)

    Koduah, A.; Dijk, van J.W.M.; Agyepong, I.A.

    2016-01-01

    Background: Why issues get on the policy agenda, move into policy formulation and implementation while others drop off in the process is an important field of enquiry to inform public social policy development and implementation. This paper seeks to advance our understanding of health policy agenda

  16. Policy Integration and Multi-Level Governance: Dealing with the Vertical Dimension of Policy Mix Designs

    Directory of Open Access Journals (Sweden)

    Michael Howlett

    2017-05-01

    Full Text Available Multifaceted problems such as sustainable development typically involve complex arrangements of institutions and instruments and the subject of how best to design and operate such ‘mixes’, ‘bundles’ or ‘portfolios’ of policy tools is an ongoing issue in this area. One aspect of this question is that some mixes are more difficult to design and operate than others. The paper argues that, ceteris paribus, complex policy-making faces substantial risks of failure when horizontal or vertical dimensions of policy-making are not well integrated. The paper outlines a model of policy mix types which highlights the design problems associated with more complex arrangements and presents two case studies of similarly structured mixes in the areas of marine parks in Australia and coastal zone management in Europe—one a failure and the other a successful case of integration—to illustrate how such mixes can be better designed and managed more effectively.

  17. Dispersed Trading and the Prevention of Market Failure

    DEFF Research Database (Denmark)

    Porter, David C.; Tanggaard, Carsten; G. Weaver, Daniel

    With augmented demands on power grids resulting in longer and larger blackouts combined with heightened concerns of terrorist attacks, trading institutions and policy makers have widened their search for systems that avoid market failure during these disturbing events. We provide insight into thi......With augmented demands on power grids resulting in longer and larger blackouts combined with heightened concerns of terrorist attacks, trading institutions and policy makers have widened their search for systems that avoid market failure during these disturbing events. We provide insight...... into this issue by examining trading behavior at the Copenhagen Stock Exchange during a major blackout. We find that although market quality declined, markets remained functional and some price discovery occurred during the blackout period suggesting that the NOREX structure of interlinked trading systems...... combined with widely dispersed trading locations may be a viable means of protection against market failure during massive power disruptions or terrorist attacks....

  18. Image and Substance Failures in Regional Organisations: Causes, Consequences, Learning and Change?

    Directory of Open Access Journals (Sweden)

    Meng Hsuan Chou

    2016-08-01

    Full Text Available States often pool their sovereignty, capacity and resources to provide regionally specific public goods, such as security or trade rules, and regional organisations play important roles in international relations as institutions that attempt to secure peace and contribute to achieving other similar global policy goals. We observe failures occurring in these arrangements and activities in two areas: substance and image. To analytically account for this, we distinguish four modes of substance and image change and link these to specific types of failure and (lack of learning. To empirically ground and test our assumptions, we examine instances of image failure in ASEAN (political/security policy and substantive policy failure in EU labour migration policy. In so doing, this article contributes to several different fields of study and concepts that have hitherto rarely engaged with one another: analyses of policy failure from public policy, and regional integration concerns from area studies and international relations. We conclude with suggestions for ways forward to further analyse and understand failures at the international and supranational levels.

  19. Image and Substance Failures in Regional Organisations: Causes, Consequences, Learning and Change?

    Directory of Open Access Journals (Sweden)

    Meng Hsuan Chou

    2016-08-01

    Full Text Available States often pool their sovereignty, capacity and resources to provide regionally specific public goods, such as security or trade rules, and regional organisations play important roles in international relations as institutions that attempt to secure peace and contribute to achieving other similar global policy goals. We observe failures occurring in these arrangements and activities in two areas: substance and image. To analytically account for this, we distinguish four modes of substance and image change and link these to specific types of failure and (lack of learning. To empirically ground and test our assumptions, we examine instances of image failure in ASEAN (political/security policy and substantive policy failure in EU labour migration policy. In so doing, this article contributes to several different fields of study and concepts that have hitherto rarely engaged with one another: analyses of policy failure from public policy, and regional integration concerns from area studies and international relations. We conclude with suggestions for ways forward to further analyse and understand failures at the international and supranational levels.

  20. Brain natriuretic peptide and optimal management of heart failure

    Institute of Scientific and Technical Information of China (English)

    LI Nan; WANG Jian-an

    2005-01-01

    Aside from the important role of brain natriuretic peptide (BNP) in diagnosis, and differential diagnosis of heart failure, this biological peptide has proved to be an independent surrogate marker of rehospitalization and death of the fatal disease.Several randomized clinical trials demonstrated that drugs such as beta blocker, angiotensin converting enzyme inhibitor, spironolactone and amiodarone have beneficial effects in decreasing circulating BNP level during the management of chronic heart failure. The optimization of clinical decision-making appeals for a representative surrogate marker for heart failure prognosis. The serial point-of-care assessments of BNP concentration provide a therapeutic goal of clinical multi-therapy and an objective guidance for optimal treatment of heart failure. Nevertheless new questions and problems in this area remain to be clarified. On the basis of current research advances, this article gives an overview of BNP peptide and its property and role in the management of heart failure.

  1. Failure is an option: Reactions to failure in elementary engineering design projects

    Science.gov (United States)

    Johnson, Matthew M.

    Recent reform documents in science education have called for teachers to use epistemic practices of science and engineering researchers to teach disciplinary content (NRC, 2007; NRC, 2012; NGSS Lead States, 2013). Although this creates challenges for classroom teachers unfamiliar with engineering, it has created a need for high quality research about how students and teachers engage in engineering activities to improve curriculum development and teaching pedagogy. While framers of the Next Generation Science Standards (NRC, 2012; NGSS Lead States 2013) focused on the similarities of the practices of science researchers and engineering designers, some have proposed that engineering has a unique set of epistemic practices, including improving from failure (Cunningham & Carlsen, 2014; Cunningham & Kelly, in review). While no one will deny failures occur in science, failure in engineering is thought of in fundamentally different ways. In the study presented here, video data from eight classes of elementary students engaged in one of two civil engineering units were analyzed using methods borrowed from psychology, anthropology, and sociolinguistics to investigate: 1) the nature of failure in elementary engineering design; 2) the ways in which teachers react to failure; and 3) how the collective actions of students and teachers support or constrain improvement in engineering design. I propose new ways of considering the types and causes of failure, and note three teacher reactions to failure: the manager, the cheerleader, and the strategic partner. Because the goal of iteration in engineering is improvement, I also studied improvement. Students only systematically improve when they have the opportunity, productive strategies, and fair comparisons between prototypes. I then investigate the use of student engineering journals to assess learning from the process of improvement after failure. After discussion, I consider implications from this work as well as future research

  2. Policy analysis: palliative care in Ireland.

    Science.gov (United States)

    May, Peter; Hynes, Geralyn; McCallion, Philip; Payne, Sheila; Larkin, Philip; McCarron, Mary

    2014-03-01

    Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the 'policy analysis triangle' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. Policy analysis: palliative care in Ireland.

    LENUS (Irish Health Repository)

    Larkin, P

    2014-03-01

    Palliative care for patients with advanced illness is a subject of growing importance in health services, policy and research. In 2001 Ireland became one of the first nations to publish a dedicated national palliative care policy. This paper uses the \\'policy analysis triangle\\' as a framework to examine what the policy entailed, where the key ideas originated, why the policy process was activated, who were the key actors, and what were the main consequences. Although palliative care provision expanded following publication, priorities that were unaddressed or not fully embraced on the national policy agenda are identified. The factors underlying areas of non-fulfilment of policy are then discussed. In particular, the analysis highlights that policy initiatives in a relatively new field of healthcare face a trade-off between ambition and feasibility. Key policy goals could not be realised given the large resource commitments required; the competition for resources from other, better-established healthcare sectors; and challenges in expanding workforce and capacity. Additionally, the inherently cross-sectoral nature of palliative care complicated the co-ordination of support for the policy. Policy initiatives in emerging fields such as palliative care should address carefully feasibility and support in their conception and implementation.

  4. A Literature Review of School Practices to Overcome School Failure. OECD Education Working Papers, No. 68

    Science.gov (United States)

    Faubert, Brenton

    2012-01-01

    The purpose of this report is to review the body of literature concerned with reducing school failure by improving equity in schools and classrooms. The literature review will be used to inform the Organisation for Economic Cooperation and Development (OECD) Project "Overcoming School Failure: Policies that Work" and hopefully, future educational…

  5. Poverty and Aspirations Failure

    NARCIS (Netherlands)

    Dalton, P.S.; Ghosal, S.; Mani, A.

    2011-01-01

    We develop a theoretical framework to study the psychology of poverty and 'aspirations failure'. In our framework, the rich and the poor share the same preferences - and also a behavioral bias in setting aspirations. Greater downside risks imposed by poverty exacerbates the effects of this behaviora

  6. Acute liver failure

    DEFF Research Database (Denmark)

    Bernal, William; Lee, William M; Wendon, Julia

    2015-01-01

    Over the last three decades acute liver failure (ALF) has been transformed from a rare and poorly understood condition with a near universally fatal outcome, to one with a well characterized phenotype and disease course. Complex critical care protocols are now applied and emergency liver...

  7. Heart failure in COPD

    NARCIS (Netherlands)

    Rutten, Frans Hendrik

    2005-01-01

    The main aim of the thesis was to assess the prevalence of heart failure in patients with a diagnosis of chronic obstructive pulmonary disease (COPD). Furthermore, to explore diagnostic strategies (including natriuretic peptides and cardiovascular magnetic resonance imaging (CMR)) to identify heart

  8. Copeptin in Heart Failure

    DEFF Research Database (Denmark)

    Balling, Louise; Gustafsson, Finn

    2016-01-01

    Heart failure (HF) is one of the most common causes of hospitalization and mortality in the modern Western world and an increasing proportion of the population will be affected by HF in the future. Although HF management has improved quality of life and prognosis, mortality remains very high...

  9. Perioperative acute renal failure.

    LENUS (Irish Health Repository)

    Mahon, Padraig

    2012-02-03

    PURPOSE OF REVIEW: Recent biochemical evidence increasingly implicates inflammatory mechanisms as precipitants of acute renal failure. In this review, we detail some of these pathways together with potential new therapeutic targets. RECENT FINDINGS: Neutrophil gelatinase-associated lipocalin appears to be a sensitive, specific and reliable biomarker of renal injury, which may be predictive of renal outcome in the perioperative setting. For estimation of glomerular filtration rate, cystatin C is superior to creatinine. No drug is definitively effective at preventing postoperative renal failure. Clinical trials of fenoldopam and atrial natriuretic peptide are, at best, equivocal. As with pharmacological preconditioning of the heart, volatile anaesthetic agents appear to offer a protective effect to the subsequently ischaemic kidney. SUMMARY: Although a greatly improved understanding of the pathophysiology of acute renal failure has offered even more therapeutic targets, the maintenance of intravascular euvolaemia and perfusion pressure is most effective at preventing new postoperative acute renal failure. In the future, strategies targeting renal regeneration after injury will use bone marrow-derived stem cells and growth factors such as insulin-like growth factor-1.

  10. Failure to thrive

    Science.gov (United States)

    ... caused by medical problems or factors in the child’s environment, such as abuse or neglect. There are many medical causes of failure to thrive. These include: Problems with genes, such as Down syndrome Organ problems Hormone problems Damage to the brain ...

  11. Equilibria with Coordination Failures

    NARCIS (Netherlands)

    Herings, P.J.J.; van der Laan, G.; Talman, A.J.J.

    2004-01-01

    This paper extends the recent literature on equilibria with coordination failures to arbitrary convex sets of admissible prices.We introduce a new equilibrium concept, called quantity constrained equilibrium (QCE), giving a uni.ed treatment to all cases considered in the literature so far.At a QCE

  12. Poverty and Aspirations Failure

    NARCIS (Netherlands)

    Dalton, P.S.; Ghosal, S.; Mani, A.

    2011-01-01

    We develop a theoretical framework to study the psychology of poverty and 'aspirations failure'. In our framework, the rich and the poor share the same preferences - and also a behavioral bias in setting aspirations. Greater downside risks imposed by poverty exacerbates the effects of this behaviora

  13. A Maintenance Model Based on Phase Type Distribution for Equipment under Two Types of Failures

    Institute of Scientific and Technical Information of China (English)

    YIN Xiao-hu; WEN Xi-sen; YANG Yong-min; QIAN Yan-ling

    2007-01-01

    A maintenance model is put forward for equipment, which is subjected to internal and external failures. In the model, two maintenance policies-perfect minimal repair and replacement are considered. The operational time has a phase type distribution (PH distribution). Failures' arrival follows a Markovian Arrival Process (MAP). Some failures require the replacement of the system, and others minimal repairs. The performance measures-the mean number of minimal repairs and replacements are analyzed and calculated.

  14. Policy-Making Theory as an Analytical Framework in Policy Analysis: Implications for Research Design and Professional Advocacy.

    Science.gov (United States)

    Sheldon, Michael R

    2016-01-01

    Policy studies are a recent addition to the American Physical Therapy Association's Research Agenda and are critical to our understanding of various federal, state, local, and organizational policies on the provision of physical therapist services across the continuum of care. Policy analyses that help to advance the profession's various policy agendas will require relevant theoretical frameworks to be credible. The purpose of this perspective article is to: (1) demonstrate the use of a policy-making theory as an analytical framework in a policy analysis and (2) discuss how sound policy analysis can assist physical therapists in becoming more effective change agents, policy advocates, and partners with other relevant stakeholder groups. An exploratory study of state agency policy responses to address work-related musculoskeletal disorders is provided as a contemporary example to illustrate key points and to demonstrate the importance of selecting a relevant analytical framework based on the context of the policy issue under investigation. © 2016 American Physical Therapy Association.

  15. Legitimizing policies

    DEFF Research Database (Denmark)

    Jørgensen, Martin Bak

    2012-01-01

    , upholding and promoting humanitarian aspects of migration management. Legitimizing policies therefore become extremely important as governments have to appease national voters to remain in power and have to respect European regulations and international conventions. Doing so raises questions of social......The focus of this article is on representations of irregular migration in a Scandinavian context and how irregular migrants are constructed as a target group. A common feature in many (Western-)European states is the difficult attempt to navigate between an urge for control and respecting...

  16. Advertisement Policy

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2014-06-01

    Full Text Available Indian Journal of Community Health (IJCH, the official publication of Indian Association of Preventive and Social Medicine (IAPSM published from Uttar Pradesh and Uttarakhand, India is an indexed journal published quarterly. The open access policy of the journals ensure good visibility of the online content of the journals. The journal with high circulation and visibility, thus offer excellent media for promotion of your products, services or conferences through advertisement. The journal has the potential to deliver the message to the targeted audience regularly with each issue. The cost of investment per view is substantially low for our print as well as electronic journals.

  17. Contraceptive failure: levels, trends and determinants in Matlab, Bangladesh.

    Science.gov (United States)

    Bairagi, R; Islam, M M; Barua, M K

    2000-01-01

    This study investigated the levels, trends and determinants of contraceptive use-failure in Matlab, Bangladesh, using a set of prospective data on 25,960 women of reproductive age. The data were extracted from the Record Keeping System (RKS) of Matlab for the period 1978-94. If there was any live birth during the use or within 7 months after the discontinuation of use, it was considered as a failure. The life table technique and hazard model were used as analytical tools. The results suggest that use-failure for pills, IUDs (TCu 200) and injectables and other temporary methods increased from 1978 to 1988, but began to decline after 1988. The cumulative probability of first-method failure within 1 year of method acceptance of the cohort of 1990-94 acceptors was 12.9% for pills, 2.0% for IUDs, 0.5% for injectables, 22.0% for condoms and 13.4% for 'other' methods (sampoon, foam, jelly and traditional methods). For pills, condoms and 'other' methods, the likelihood of failure declined with the duration of use; by contrast, the probability of an IUD failure increased over time, peaking at 3 years of use. The injectables maintained a low likelihood of failure regardless of the duration of use. The quality of Community Health Workers' (CHWs) performance was associated with the risk of failure of all temporary methods except condoms; women's background characteristics associated with failure varied by method. The effect of the quality of the CHWs' performance and the background variables on failure did not change much over time. It is felt that contraceptive failure deserves the serious attention of programme managers and policy makers to make the Bangladesh national family planning programme more successful.

  18. Advance Directives

    Science.gov (United States)

    ... Data Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... Process Introduction to Grants Process NCI Grant Policies Legal Requirements Apply for a Grant Step 1: Application ...

  19. Advance care directives

    Science.gov (United States)

    ... advance directive; Do-not-resuscitate - advance directive; Durable power of attorney - advance care directive; POA - advance care directive; Health care agent - advance care directive; Health care proxy - ...

  20. [Effect of angiotensin II receptor antagonist (losartan) on renal function, serum potassium and blood pressure in patients with advanced renal failure: differences between patients with a serum creatinine (SCr) level higher than 3 mg/dl and those with a lower SCr level].

    Science.gov (United States)

    Nakayama, Masaaki; Tanno, Yudo; Otsuka, Yasushi; Takahashi, Hajime; Ikeda, Masato; Katoh, Naohiko; Yokoyama, Keitaro; Yamamoto, Hiroyasu; Tokutome, Goro; Hosoya, Tatsuo

    2002-10-01

    The administration of angiotensin II receptor antagonist(AIIA) to patients with advanced chronic renal failure(CRF) is not actively recommended. This study was performed to verify the appropriateness of this situation and to determine if there are any substantial differences between patients with a serum creatinine(SCr) level higher than 3 mg/dl and those with a lower SCr level in terms of the clinical effects such as renal function, serum potassium level and systemic blood pressure(BP) after the administration of AIIA. Sixteen patients with advanced CRF who were admitted to the out-patient clinic in Jikei University Hospital(1998/1-1999/12) were enrolled(average age: 65 years, underlying renal disease: diabetic nephropathy 6, CGN 5, and other 1). They had never been administered AIIA before. The patients were classified into two groups in accordance with their level of SCr: group A(SCr lower than 3.0 mg/dl; n = 11), and Group B(SCr higher than 3.0 mg/dl; n = 5). Losartan(50 mg/day) administration was started in order to examine parameters such as the SCr, potassium, BP at the out-patient clinic, and urinary protein excretion at the 0, 1, 3, 6, 9, and 12 month time points. Although the 1/SCr values provided negative slopes with time in both groups, no significant difference was found between the two slopes. There were no changes in the serum potassium levels or urinary protein excretion during the study period in either group, and no statistical difference was found between the two groups. Although the serum potassium level exceeded 5.5 mEq/l in two patients each in both groups, the level was controlled by diet therapy with restricted potassium. BP was reduced significantly in both groups during the study period, and no statistical difference in BP reduction was observed between the two groups. In conclusion, the results indicate there were no differences in the effect on renal function, serum potassium levels or systemic BP between the patients with a SCr level